Information Return for Small Tax-Exempt

Governmental Bond Issues, Leases, and Installment Sales Form 8038-GC

OMB No. 1545-0720

© Under Internal Revenue Code section 149(e)

Department of the Treasury

Internal Revenue Service Caution: Use Form 8038-G if the issue price of the issue is $100,000 or more.

Reporting Authority Check box if Amended Return ©

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 City, town, or post office, state, and ZIP code

Description of Obligations (Check if reporting: a single issue or on a consolidated basis .)

8a Issue price of obligation(s) (see instructions) 8a

b

9 Amount of the reported obligation(s) on line 8a:

a Used to refund prior issue(s) 9a

b Representing a loan from the proceeds of another tax-exempt obligation (e.g., bond bank) 9b

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

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

Sign

Here

Issuer’s authorized representative Date Type or print name and title

Who Must File

General Instructions

Section references are to the Internal

Revenue Code unless otherwise noted.

Form 8038–GC (Rev. 5-99)

Part I

Part II

© ©

Cat. No. 64108B

Room/suite

(Rev. May 1999)

10 If the issuer has designated any issue under section 265(b)(3)(B)(i)(III) (small issuer exception), check this box ©

Purpose of Form

Form 8038-GC is used by the issuers of

tax-exempt governmental obligations to

provide the IRS with the information required

by section 149(e) and to monitor the

requirements of sections 141 through 150.

Issuers of tax-exempt governmental

obligations with issue prices of less than

$100,000 must file Form 8038-GC.

Issuers of a tax-exempt governmental

obligation with an issue price of $100,000 or

more must file Form 8038-G, Information

Return for Tax-Exempt Governmental

Obligations.

Filing a separate return. Issuers have the

option to file a separate Form 8038-GC for

any tax-exempt governmental obligation with

an issue price of less than $100,000.

Filing a consolidated return. For all

tax-exempt governmental obligations with

issue prices of less than $100,000 that are

not reported on a separate Form 8038-GC,

an issuer must file a consolidated information

return including all such issues issued within

the calendar year.

Thus, an issuer may file a separate Form

8038-GC for each of a number of small

issues and report the remainder of small

issues issued during the calendar year on one

consolidated Form 8038-GC. However, a

separate Form 8038-GC must be filed to give

the IRS notice of the election to pay a penalty

in lieu of arbitrage rebate.

An issuer of a tax-exempt bond used to

finance construction expenditures must file a

separate Form 8038-GC for each issue to

give notice to the IRS that an election was

made to pay a penalty in lieu of arbitrage

rebate (see the line 12 instructions).

Late filing. An issuer may be granted an

extension of time to file Form 8038-GC under

Section 3 of Rev. Proc. 88-10, 1988-1 C.B.

635, if it is determined that the failure to file

on time is not due to willful neglect. Type or

print at the top of the form, “This Statement

Is Submitted in Accordance with Rev. Proc.

88-10.” Attach to the Form 8038-GC a letter

briefly stating why the form was not

submitted to the IRS on time. Also indicate

whether the obligation in question is under

examination by the IRS. Do not submit copies

of any bond documents, leases, or installment

sale documents.

When To File

To file a separate return, file Form 8038-GC

on or before the 15th day of the second

calendar month after the close of the

calendar quarter in which the issue is issued.

To file a consolidated return, file Form

8038-GC on or before February 15th of the

calendar year following the year in which the

issue is issued.

6 Name and title of officer or legal representative whom the IRS may call for more information

5 Report number

7 Telephone number of officer or legal representative

GC –

( )

Issue date (single issue) or calendar year (consolidated) (see instructions) ©

11

12

If any obligation is in the form of a lease or installment sale, check this box ©

If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check this box ©

Definitions

Obligations. This refers to a single

tax-exempt governmental obligation if Form

8038-GC is used for separate reporting or to

multiple tax-exempt governmental obligations

if the form is used for consolidated reporting.

Rounding to Whole Dollars

You may show the money items on this

return as whole-dollar amounts. To do so,

drop any amount less than 50 cents and

increase any amount from 50 cents through

99 cents to the next higher dollar.

Other Forms That May Be Required

For rebating arbitrage (or paying a penalty in

lieu of arbitrage rebate) to the Federal

government, use Form 8038-T, Arbitrage

Rebate and Penalty in Lieu of Arbitrage

Rebate. For private activity bonds, use Form

8038, Information Return for Tax-Exempt

Private Activity Bond Issues.

Where To File

File Form 8038-GC with the Internal Revenue

Service Center, Ogden, UT 84201.

Tax-exempt obligation. This is a bond,

installment purchase agreement, or financial

lease, on which the interest is excluded from

income under section 103.

Tax-exempt governmental obligation. A

tax-exempt obligation that is not a private

activity bond (see below) is a tax-exempt

governmental obligation. This includes a bond

issued by a qualified volunteer fire

department under section 150(e).

Private activity bond. This includes an

obligation issued as part of an issue in which:

● More than 10% of the proceeds are to be

used for any private activity business use,

and
Form 8038-GC (Rev. 5-99) Page 2

Specific Instructions

Part I—Reporting Authority

Amended return. If this is an amended Form

8038-GC, check the amended return box.

Complete Part I and only those lines of Form

8038-GC that are being amended. Do not

amend estimated amounts previously

reported once the actual amounts are

determined. (See the Part II instructions

below.)

Line 1. The issuer’s name is the name of the

entity issuing the obligations, not the name of

the entity receiving the benefit of the

financing. In the case of a lease or installment

sale, the issuer is the lessee or purchaser.

Line 2. An issuer that does not have an

employer identification number (EIN) should

apply for one on Form SS-4, Application for

Employer Identification Number. This form

may be obtained at Social Security

Administration offices or by calling

1-800-TAX-FORM. If the EIN has not been

received by the due date for Form 8038-GC,

write “Applied for” in the space for the EIN.

Part II—Description of

Arbitrage rebate. Generally, interest on a Obligations state or local bond is not tax exempt unless

the issuer of the bond rebates to the United

States arbitrage profits earned from investing

proceeds of the bond in higher yielding

nonpurpose investments. See section 148(f).

Construction issue. This is an issue of

tax-exempt bonds that meets both of the

following conditions:

Line 12. Check this box if the issue is a

construction issue and an irrevocable election

to pay a penalty in lieu of arbitrage rebate

has been made on or before the date the

bonds were issued. The penalty is payable

with a Form 8038-T for each 6-month period

after the date the bonds are issued. Do not

make any payment of penalty in lieu of rebate

with this form. See Rev. Proc. 92-22, 1992-1

C.B. 736, for rules regarding the “election

document.”

In general, a Form 8038-GC must be

completed on the basis of available

information and reasonable expectations as

of the date the issue is issued. However,

forms that are filed on a consolidated basis

may be completed on the basis of information

readily available to the issuer at the close of

the calendar year to which the form relates,

supplemented by estimates made in good

faith.

If you have comments concerning the

accuracy of these time estimates or

suggestions for making this form simpler, we

would be happy to hear from you. You can

write to the Tax Forms Committee, Western

Area Distribution Center, Rancho Cordova,

CA 95743-0001. DO NOT send the form to

this address. Instead, see Where To File on

page 1.

Paperwork Reduction Act Notice

We ask for the information on this form to

carry out the Internal Revenue laws of the

United States. You are required to give us the

information. We need it to ensure that you are

complying with these laws.

The time needed to complete and file this

form varies depending on individual

circumstances. The estimated average time

is:

Learning about the

law or the form 1 hr., 51 min.

Preparing the form 2 hr., 56 min.

Copying, assembling, and

sending the form to the IRS 16 min.

You are not required to provide the

information requested on a form that is

subject to the Paperwork Reduction Act

unless the form displays a valid OMB control

number. Books or records relating to a form

or its instructions must be retained as long as

their contents may become material in the

administration of any Internal Revenue law.

Generally, tax returns and return information

are confidential, as required by section 6103.

In lieu of rebating any arbitrage that may

be owed to the United States, the issuer of a

construction issue may make an irrevocable

election to pay a penalty. The penalty is equal

to 11⁄2% of the amount of construction

proceeds that do not meet certain spending

requirements. See section 148(f)(4)(C) and the

Instructions for Form 8038-T.

1. At least 75% of the available

construction proceeds of the issue are to be

used for construction expenditures with

respect to property to be owned by a

governmental unit or a 501(c)(3) organization,

and

2. All of the bonds that are part of the issue

are qualified 501(c)(3) bonds, bonds that are

not private activity bonds, or private activity

bonds issued to finance property to be

owned by a governmental unit or a 501(c)(3)

organization.

Line 5. Number reports consecutively based

on the filing date (not the date of issue). For

example, if the issuer has already filed two

Forms 8038-GC in the 1999 calendar year,

the report number for the third Form 8038-GC

would be “GC1999-3.”

Line 8a. The issue price of obligations is

generally determined under Regulations

section 1.148-1(b). Thus, when issued for

cash, the issue price is the price at which a

substantial amount of the obligations are sold

to the public. To determine the issue price of

an obligation issued for property, see

sections 1273 and 1274 and the related

regulations.

Line 8b. For a single issue, enter the date of

issue, generally the date on which the issuer

physically exchanges the bonds that are part

of the issue for the underwriter’s (or other

purchaser’s) funds; for a lease or installment

sale, enter the date interest starts to accrue.

For issues reported on a consolidated basis,

enter the calendar year during which the

obligations were issued.

Lines 9a and 9b. For line 9a, enter the

amount of the proceeds that will be used to

pay principal, interest, or call premium on any

other issue of bonds, including proceeds that

will be used to fund an escrow account for

this purpose. Both line 9a and 9b may apply

to a particular obligation. For example, report

on line 9a and 9b obligations used to refund

prior issues which represent loans from the

proceeds of another tax-exempt obligation.

Line 11. Check this box if property other than

cash is exchanged for the obligation, e.g.,

acquiring a police car, a fire truck, or

telephone equipment through a series of

monthly payments. (This type of obligation is

sometimes referred to as a “municipal lease.”)

Also check this box if real property is directly

acquired in exchange for an obligation to

make periodic payments of interest and

principal. Do not check this box if the

proceeds of the obligation are received in the

form of cash, even if the term “lease” is used

in the title of the issue.

● More than 10% of the payment of principal

or interest of the issue is either (a) secured

by an interest in property to be used for a

private business use (or payments for such

property) or (b) to be derived from payments

for property (or borrowed money) used for a

private business use.

It also includes a bond, the proceeds of

which are to be used to make or finance

loans (other than loans described in section

141(c)(2)) to certain persons exceeds the

smaller of 5% of the proceeds or $5 million.

Issue. Generally, obligations are treated as

part of the same issue only if they are issued

by the same issuer, on the same date, and as

part of a single transaction, or a series of

related transactions. However, obligations

issued during the same calendar year (a)

under a loan agreement under which amounts

are to be advanced periodically (a

“draw-down loan”) or (b) with a term not

exceeding 270 days, may be treated as part

of the same issue if the obligations are

equally and ratably secured under a single

indenture or loan agreement and are issued

under a common financing arrangement (e.g.,

under the same official statement periodically

updated to reflect changing factual

circumstances). Also, for obligations issued

under a draw-down loan that meets the

requirements of the preceding sentence,

obligations issued during different calendar

years may be treated as part of the same

issue if all of the amounts to be advanced

under the draw-down loan are reasonably

expected to be advanced within 3 years of

the date of issue of the first obligation.

Likewise, obligations (other than private

activity bonds) issued under a single

agreement that is in the form of a lease or

installment sale may be treated as part of the

same issue if all of the property covered by

that agreement is reasonably expected to be

delivered within 3 years of the date of issue

of the first obligation.

Form 8038–GC (Rev. 5-99)