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ail Form 8038 - Ge Information Return for Small 'Tax-Exempt Governmental Bond issues , Leases , and Installment Sales (Rev. November _2000) t Under internal Revenue Code section 149 (e) OMB No. 1545 -0720 Departrneni the Treasury Internal Revenue service Caution: ff the issue price of the issue is $700, 000 or more, use Form 8038-G. Re ortin Authorit 1 Issuer's name Check box )f Amended Return ► ❑ 2 Issuer's employer identification number 3 Number and street (or P.O. bogilmail is not delivered to street address) f Room/suite 4 City. town. or post office. state, and ZIP code ro* �—y� ✓ 5 Report number �� c 0 ; /7 335� �� s 6 Name and title of officer or legal representative whom the IRS may call for more information 7 Telephone number of officer or legal represemative ti Descri tion of nhli ations Check if reporting : a sinq)e issue ❑ or on a consolidated basis ❑ Sa Issue price of obligation(s) (see instructions) _ b Issue date (single issue) or calendar year (consolidated) (see instructions) )IN. . . . . . . 9 Amount of the reported obligations) on line 8a : a Used to refund prior issue(s) b Representing a loan from_the proceeds- of. another tax-.exempt .obligation (e . g . , bond bank) 9b - . 10 if the issuer has designated any issue under section 265 b 3 B1111 small issuer exception), check this box 11 If any obligation is in the form of a lease or installment sale, )che(ck this box - �❑/ 12 1f the issuer has elected to Day a penalty in lieu of arbitral rebate, check this box Under penalties of per jury l declare th have examined return and accompanyingschedules and statements. and to the best of my knowledge and belief, trey are correct, and co e. Sign Here 04 - 08 - 2003R . Macht , Chairman a .o:ized representative Date 41enneth r print name . and title General. Instructions Thus, an issuer may file a separate Form pr}-)er Fai That (Vfa Section references are to the internal 8038 -GC for each of a_ number of small y _red ' issues grid repoR the Temainder of small For rebating arbitrage (or paying a penalty to Revenue Cade unless otherwise noted- issues issued during the calendar yearon one lieu of arbitrage rebate) to the Federal Purpose of Form consolidated Form -8038-GC. However, a . government, use Form8038-T, Arbitrage separate Forth 8038-GC must be filed to give Rebate and Penalty in Lieu of Arbitrage Form 8038-GC . is used by the issuers of the IRS notice of the election to pay a penalty Rebate. For private activity bonds, use Ft rm tax-exempt governmental obligations to in lieu of arbitrage rebate. 8038, information Return for Tax- Exempt . provide the IRS with -the information required Private Activity Bond Issues. by section 149(e) and to monitor the . When To Fite requirements of sections 141 through 150, To .file a separate return, file Form 8038-GC Rounding to Whole Dollars Who M_Ust File on or before the 15th day of the second You may show the moneyitems on this calendar month after the dose of the return as whole-dollar. amounts. To do so, issuers of. tax-exempt governmentalcalendar quarter in which the issue is issued . drop any amount less than 50 cents and . obligations with. issue prices of less UlanTincrease any amount from 50 to 99 cents to $ 100,000 must file Form »+38-GC, o file a consolidated return, file Form the next higher dollar. 8038-GC on or before February- 15th of the Issuers of a tax-exempt governmental calendar year following the year in which the Definitions obligation with an issue price of $100,000 or issue is issued. more must file Form 8038-G, Information Obligations. This refers to a single Return for Tax_ Exempt Govemmetltal Late Ming. An issuer may granted an tax-exempt governmental obligation if Form Obligations. extension of time to rile Farm 8038-GC under 8038-GC is used for separate reporting or to Filing urn Section 3 of Rev. Prot . 88-1A, 1988- 1 C. B . multiple tax-exempt governmental obligations ing a . separate retIssuers have the 635, if R is. determined that the failure to file if the form is used for consolidated reporting. option to file. a . separate Form 803&GC for on time is not due to willful neglect Type or arty tax-exempt govemmental obligation with print at the top of the form, "This Statement Tax-exempt obligation. This is a bond, an issue price of less than $100,000. Is Submitted in Accordance with Rev. Proc. installment purchase agreement, or financial An issuer of a tax-exempt bond used to 88- 10. 0 Attach to the Form 8038-GC a letter lease, on which the interest is excluded from finance construction expenditures must file a briefly stating why the form was not income under section 103. separate Form 8038-GC for each issue to submitted to the IRS on time. Also indicate Tax-exempt governmental obligation. A give notice. to the IRS that an election was whether the obligation in question is under tax-exempt obligation that is not a private made to pay. a penalty in lieu of arbitrage examination by the IRS: Do not submit copies activity bond (see below) is a tax-exempt rebate (see the line 12 . instructions). of any bond documents, leases, or installment governmental obligation . This includes a bond Filing a consolidated return For a4 sale documents. See Where To File below. issued by a qualified volunteer fire tax-exempt governmental obrroatiors withdepartment under section 150(e). issue prices of less than -$100':000 that are Whefe To File Private activity bond. This includes an - not reported on a separate . Form 8038 -GC, File Form 8038-GC, and any attachments, obligation issued as part of an issue in which : an issuer must file a consolidated information with the Internal Revenue Service Center, • return including all such issues issued within Ogden. UT 84201 . More than i09a of the proceeds are to be the calendar year. used for any private activity business u, and Cat. No . 641058 Form 8038—GC (Rev . 1 : - 2000)