Information Return for Tax-Exempt Governmental Obligations Form 8038-G

© Under Internal Revenue Code section 149(e) OMB No. 1545-0720

(Rev. May 1995) © See separate Instructions.

Department of the Treasury

Internal Revenue Service (Note: Use Form 8038-GC if the issue price is under $100,000.)

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

G19 -

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

7 Name of issue 8 CUSIP number

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

9

If obligations are tax or other revenue anticipation bonds, check box ©

If obligations are in the form of a lease or installment sale, check box ©

10

Education (attach schedule–see instructions) $

11

Health and hospital (attach schedule–see instructions)

12

13

Transportation

Public safety

14

Environment (including sewage bonds)

15

Housing

16

Utilities

17

Other. Describe (see instructions) ©

18

Description of Obligations

(g)

Net interest

cost

(e)

Weighted

average maturity

(d)

Stated redemption

price at maturity

(a)

Maturity date

(b)

Interest rate

(f)

Yield

(c)

Issue price

19 Final maturity %

20 Entire issue years % %

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

21 Proceeds used for accrued interest 21

22 Issue price of entire issue (enter amount from line 20, column (c)) 22

23 Proceeds used for bond issuance costs (including underwriters’ discount) 23

24 Proceeds used for credit enhancement 24

25 Proceeds allocated to reasonably required reserve or replacement fund 25

26 Proceeds used to currently refund prior issues 26

28 Total (add lines 23 through 27) 28

29 Nonrefunding proceeds of the issue (subtract line 28 from line 22 and enter amount here) 29

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

Enter the remaining weighted average maturity of the bonds to be currently refunded © years 30

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

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

Miscellaneous

34 Enter the amount of the state volume cap allocated to the issue under section 141(b)(5)

35 Enter the amount of the bonds designated by the issuer under section 265(b)(3)(B)(i)(III) (small issuer exception)

37 Pooled financings: a Proceeds of this issue that are to be used to make loans to other governmental units

b If this issue is a loan made from the proceeds of another tax-exempt issue, check box © and enter the name of the

issuer © and the date of the issue ©

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

For Paperwork Reduction Act Notice, see page 1 of the Instructions. Form 8038-G (Rev. 5-95)

Part VI

Part III

Part V

Part IV

Part I

Part II

Cat. No. 63773S

© ©

Room/suite

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

9

10

11

12

13

14

15

16

34

35

37a

39 If the issuer has identified a hedge, check box ©

27 Proceeds used to advance refund prior issues 27

Enter the remaining weighted average maturity of the bonds to be advance refunded © years 31

36a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract (see instructions)

b Enter the final maturity date of the guaranteed investment contract ©

36a

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