rom 8038-GC

(May 1987)

Department of the Treasury
Internal Revenue Service

> Under Section 149(e)
> For calendar year ending 19...

Consolidated Information Return for Small
Tax-Exempt Governmental Bond Issues

OMB No. 1545-0720
Expires 02/28/90

(Use Form 8038-G if 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,

4 City or town, state, and ZIP code

f Part 11 | Description of Bonds

5 Total issue price of all bonds issued as part of an issue, the issue price of which is less than $100,000 5
6 Check box that most nearly approximates the weighted average maturity of the bonds:
a Less than 5 years
b C1 From5 to 10 years
¢ C1] More than 10 years
7 Check box that most nearly approximates the weighted average interest rate on the bonds
aC Less than 5%
b DD From 5% to 10%
¢ More than 10%
8 Total issue price of the bonds reported on line 5 that are: Us
a Bonds issued in the form of a lease or installment sale . 8a
b Bonds designated by the issuer under section 265(b)(3)(B)(ii)_. 8b
¢ Bonds issued to refund prior issues . 8c
d Loans made from the proceeds of another tax-exempt bondissue_. 8d
Under penalties of perjury, | declare that Ihave examined this return and accompanying schedules and satervents, and to the best of my Krowledge and belt
Please they are true, correct, and complete.
Sign
Here rs of officer Date > Title

General Instructions

(Section references are to the Internal
Revenue Code unless otherwise noted.)

Changes You Should Note

All issuers of tax-exempt bonds must report
certain information about bonds they issue.
Issuers should use Form 8038-GC only if
the issue price of the issue is under
$100,000. If the issue price is $100,000 or
more, issuers should use Form 8038-G,
Information Return for Tax-Exempt
Governmental Bond Issues. For private
activity bonds, issuers should use Form
8038, Information Return for Tax-Exempt
Private Activity Bond Issues.

Paperwork Reduction Act Notice

We ask for this information to carry out the

Internal Revenue laws of the United States.
We need it to ensure that you are complying
with these laws. You are required to give us
this information.

Purpose of Form

Form 8038-GC is to be used by issuers of
tax-exempt governmental bonds to provide
IRS with the information required by section
149(e) and to monitor the requirements of
sections 141 through 150.

Who Must File

Each issuer must file a single Form 8038-GC
for all tax-exempt governmental bond issues
issued after December 31, 1986, with issue
prices of less than $100,000. Form 8038-G
is filed to report each issue of governmental
bonds with issue prices of $100,000 or
more

When To File

File Form 8038-GC on or before February
15th after the close of the calendar year in
which the issue is issued. Form 8038-GC
must be completed based on the facts as of
the close of the calendar year.

Where To File

File Form 8038-GC with the Internal
Revenue Service Center, Philadelphia, PA
19255.

Definitions

A tax-exempt bond is an obligation
issued as part of an issue the interest on
which is exempt from tax under the Internal
Revenue Code.

e A tax-exempt governmental bond is a
tax-exempt bond that is not a private activity
bond.

e A private activity bond is generally a
bond issued as part of an issue of which:

(1) more than 10% of the proceeds are to
be used for any private business use; and
(2) more than 10% of the payment of the
principal or interest either is secured by an
interest in property to be used for a private
business use (or payments in respect of
such property) or is to be derived from
payments in respect of property (or
borrowed money) used for a private
business use. A bond will also be
considered a private activity bond if the
amount of the proceeds to be used to make
or finance loans (other than loans

Form 8038-GC (5-87)


Form 8038-GC (5-87)

Page 2

described in section 141(c) (2)) to certain
persons exceeds the lesser of 5% of the
proceeds, or $5,000,000. These bonds
should be reported on Form 8038.

Note: Bonds described in section
1312(c)(2) of the Tax Reform Act of 1986
to which the transitional rules in section
1312 or 1313 apply are not private activity
bonds for purposes of information
reporting. They should be reported on Form
8038-G or Form 8038-GC.

Specific Instructions

Part |.—Reporting Authority
Amended Return.—If you are filing an
amended Form 8038-GC, check the
amended return box and complete Part |
and only those parts of Form 8038-GC you
are amending by entering the correct
information. Do not amend the estimated
amounts previously reported once the
actual amounts are determined.

Line 1.—The issuer's name is the name of
the entity issuing the bonds, not the name of
the entity receiving the benefit of the
financing.

Line 2—Issuer's employer identification
number (EIN).—If the issuer does not have
an employer identification number, enter
“none” and attach a completed Form SS-4,
Application for Employer Identification
Number, to Form 8038-GC. If, however, the
issuer has previously applied for such a
number, attach a statement giving the date
of the application and the office where it
was submitted.

Part Il.—Description of Bonds

This part may be completed based on
information readily available to the issuer
at the close of the calendar year,
supplemented by estimates made in good
faith. All entries may be based on good
faith approximations.

Line 5.—Enter the total issue price of all
tax-exempt governmental bonds issued
during the calendar year which were issued
as part of an issue, the issue price of which
is less than $100,000. If the bonds are
reoffered to the public by an intermediary,
the issue price is the reoffering price
(excluding accrued interest).

$F U.S. Government Printing Office: 1987—181-847/40146

Line 6.— The weighted average maturity is
the average maturity on the bonds with
each bond weighted to its par value.

Line 7.— The weighted average interest
rate is the average interest rate on the
bonds with each bond weighted in
proportion to its par value and its length of
maturity.

Line 8.—Enter the total issue price of the
bonds reported on line 5 that are described
on lines 8a, 8b, 8c, and 8d. More than one
line may apply to a particular bond. For
example, bonds issued to refund prior
issues which were designated by the issuer
under section 265(b)(3)(B)(ii) should be
reported on line 8b and line 8c.

Signature

Form 8038-GC must be signed by an
authorized representative of the issuer.