Information Return for Tax-Exempt

Private Activity Bond Issues Form 8038

OMB No. 1545-0720

(Under Internal Revenue Code section 149(e)) Department of the Treasury

Internal Revenue Service © See separate instructions.

Reporting Authority If Amended Return, check here ©

1 Issuer’s name 2 Issuer’s employer identification number

3 Number and street (or P.O. box if mail is not delivered to street address) 4 Report number

PA -

5 City, town, or post office, state, and ZIP code 6 Date of issue

7 Name of issue 8 CUSIP number

Type of Issue (check applicable box(es) and enter the issue price for each) Issue Price

11 Exempt facility bond:

11a a Airport (sections 142(a)(1) and 142(c))

b Docks and wharves (sections 142(a)(2) and 142(c)) 11b

11d d

Water furnishing facilities (sections 142(a)(4) and 142(e))

11e e

Sewage facilities (section 142(a)(5))

11f f

Solid waste disposal facilities (section 142(a)(6))

Qualified residential rental projects (sections 142(a)(7) and 142(d)), as follows:

Meeting 20–50 test (section 142(d)(1)(A))

Meeting 40–60 test (section 142(d)(1)(B))

Meeting 25–60 test (NYC only) (section 142(d)(6))

Has an election been made for deep rent skewing (section 142(d)(4)(B))? No Yes

Facilities for the local furnishing of electric energy or gas (sections 142(a)(8) and 142(f)) 11g

h

i

Facilities allowed under a transitional rule of the Tax Reform Act of 1986 (see instructions) 11h

Facility type

1986 Act section

11j

Qualified mortgage bond (section 143(a))

Qualified veterans’ mortgage bond (section 143(b)) © 13

If you elect to rebate arbitrage profits to the United States, check box

Qualified small issue bond (section 144(a)) (see instructions) © 14

12

For $10 million small issue exemption, check box

16

Qualified student loan bond (section 144(b))

13

17

Qualified redevelopment bond (section 144(c))

14

18

Qualified hospital bond (section 145(c)) (attach schedule—see instructions)

15

Qualified 501(c)(3) nonhospital bond (section 145(b)) (attach schedule—see instructions)

16

19

Check box if 95% or more of net proceeds will be used only for capital expenditures ©

17

Other. Describe (see instructions) ©

18

20

Description of Bonds (Complete for the entire issue for which this form is being filed.)

(c) Stated redemption

price at maturity

(d) Weighted

average maturity

(a) Final maturity date (b) Issue price (e) Yield

21 $ $ years %

For Paperwork Reduction Act Notice, see page 4 of the Instructions. Form 8038 (Rev. 1-99)

Part III

Part I

Part II

Cat. No. 49973K

(Rev. January 1999)

Room/suite

Qualified enterprise zone facility bonds (section 1394) (see instructions) 11i

9 Name and title of officer or legal representative whom the IRS may call for more information 10 Telephone number of officer or legal representative

( )

c 11c

g

20

19 Nongovernmental output property bond (treated as private activity bond) (section 141(d))

j Qualified “new” empowerment zone facility bonds (section 1394(f)) (see instructions)

l Other. Describe (see instructions) © 11l

12

15

k District of Columbia Enterprise Zone facility bonds (section 1400A) (see instructions) 11k
Form 8038 (Rev. 1-99) Page 2

Uses of Proceeds of Issue (including underwriters’ discount) Amount

22 Proceeds used for accrued interest 22

23 Issue price of entire issue (enter amount from line 21, column (b)) 23

24 Proceeds used for bond issuance costs (including underwriters’ discount) 24

25 Proceeds used for credit enhancement 25

26 Proceeds allocated to reasonably required reserve or replacement fund 26

27 27

29 Total (add lines 24 through 28) 29

30 Nonrefunding proceeds of the issue (subtract line 29 from line 23 and enter amount here) 30

Description of Property Financed by Nonrefunding Proceeds

31 Type of Property Financed by Nonrefunding Proceeds:

a Land 31a

b Buildings and structures 31b

c Equipment with recovery period of more than 5 years 31c

d Equipment with recovery period of 5 years or less 31d

e Other (describe) 31e

32 North American Industry Classification System (NAICS) of the projects financed by nonrefunding proceeds.

NAICS Code Amount of nonrefunding proceeds NAICS Code Amount of nonrefunding proceeds

a c

b d

Description of Refunded Bonds (Complete this part only for refunding bonds.)

33 Enter the remaining weighted average maturity of the bonds to be currently refunded © years

35 Enter the last date on which the refunded bonds will be called ©

36 Enter the date(s) the refunded bonds were issued ©

Miscellaneous

37 Name of governmental unit(s) approving issue (see instructions) ©

38 Check box if you have designated any issue under section 265(b)(3)(B)(i)(III) ©

Volume Caps

41 Amount of state volume cap allocated to the issuer. Attach copy of state certification 41

42 Amount of issue subject to the unified state volume cap 42

43 Amount of issue not subject to the unified state volume cap or other volume limitations:

a Of bonds for governmentally owned solid waste facilities, airports, docks, wharves, environmental

enhancements of hydroelectric generating facilities, or high-speed intercity rail facilities

43

43a

b Under a carryforward election. Attach a copy of Form 8328 to this return 43b

c Under transitional rules of the Tax Reform Act of 1986 (enter Act section no.) © 43c

Under the exception for current refunding (section 146(i) and section 1313(a) of the Tax Reform

Act of 1986)

d

43d

44a

44b

45a

44a Amount of issue of qualified veterans’ mortgage bonds

b Enter the state limit on qualified veterans’ mortgage bonds

Under penalties of perjury, I declare that I have examined this return, and accompanying schedules and statements, and to the best of my knowledge

and belief, they are true, correct, and complete.

Please

Sign

Here

Signature of officer Date

Name of above officer (type or print) Title of officer (type or print)

Part VIII

Part VII

Part VI

Part V

Part IV

Amount

Amount

© ©

39 Check box if you have elected to pay a penalty in lieu of arbitrage rebate ©

$

$ $

$

40 Check box if you have identified a hedge (see instructions) ©

Caution: The total of lines 31a through e below must equal line 30 above. Do not complete for qualified student loan

bonds, qualified mortgage bonds, or qualified veterans’ mortgage bonds.

45a Amount of section 1394(f) volume cap allocated to issuer. Attach copy of local government

certification

b Name of empowerment zone ©

28

Proceeds used to currently refund prior issue (complete Part VI)

28 Proceeds used to advance refund prior issue (complete Part VI)

34 Enter the remaining weighted average maturity of the bonds to be advance refunded © years