T3030 Appendix 5 Form 8038-GC and Form 8038-G Revised as of 10.2021 1.29.26.pdf

APPENDIX 5

FORM 8038-GC and FORM 8038-G

Form 8038-GC (Rev. October 2021) - Information Return for Small Tax-Exempt Governmental Bond Issues, Leases, and Installment Sales; and

Form 8038-G (Rev. October 2021) - Information Return for Tax-Exempt Governmental Bonds

25DPP01105 T3030 Appendix 5 Form 8038-GC and Form 8038-G Revised as of 10.2021

Form 8038-GC (Rev. October 2021)

Information Return for Small Tax-Exempt Governmental Bond Issues, Leases, and Installment Sales

Department of the Treasury Internal Revenue Service

▶ Under Internal Revenue Code section 149(e) Caution: If the issue price of the issue is $100,000 or more, use Form 8038-G.

▶ Go to www.irs.gov/Form8038GC for instructions and the latest information.

OMB No. 1545-0047

Part I Reporting Authority Check box if Amended Return ▶ 1 Issuer’s name 2 Issuer’s employer identification number (EIN)

3 Number and street (or P.O. box if mail isn’t delivered to street address) Room/suite

4 City, town, or post office, state, and ZIP code 5 Report number (For IRS Use Only)

6 Name and title of officer or other employee of issuer or designated contact person whom the IRS may call for more information 7 Telephone number of officer or legal representative

Part II Description of Obligations Check one box: Single issue Consolidated return 8a Issue price of obligation(s) (see instructions) . . . . . . . . . . . . . . . . . . . 8a b Issue date (single issue) or calendar date (consolidated). Enter date in MM/DD/YYYY format (for example, 01/01/2009) (see instructions) ▶

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

a For leases for vehicles . . . . . . . . . . . . . . . . . . . . . . . . . . 9a b For leases for office equipment . . . . . . . . . . . . . . . . . . . . . . . . 9b c For leases for real property . . . . . . . . . . . . . . . . . . . . . . . . . 9c d For leases for other (see instructions) . . . . . . . . . . . . . . . . . . . . . . 9d e For bank loans for vehicles . . . . . . . . . . . . . . . . . . . . . . . . . 9e f For bank loans for office equipment . . . . . . . . . . . . . . . . . . . . . . 9f g For bank loans for real property . . . . . . . . . . . . . . . . . . . . . . . 9g h For bank loans for other (see instructions) . . . . . . . . . . . . . . . . . . . . 9h i Used to refund prior issue(s) . . . . . . . . . . . . . . . . . . . . . . . . 9i j Representing a loan from the proceeds of another tax-exempt obligation (for example, bond bank) . 9j k Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9k

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

11 If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check this box (see instructions) . . . . . . . ▶ 12 Vendor’s or bank’s name:

13 Vendor’s or bank’s employer identification number:

Signature and Consent

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. I further declare that I consent to the IRS’s disclosure of the issuer’s return information, as necessary to process this return, to the person(s) that I have authorized above.

Signature of issuer’s authorized representative Date

Type or print name and title

Paid Preparer Use Only

Print/Type preparer’s name Preparer’s signature Date Check if self-employed

PTIN

Firm’s name ▶ Firm’s EIN ▶

Firm’s address ▶ Phone no.

Future Developments For the latest information about developments related to Form 8038-GC and its instructions, such as legislation enacted after they were published, go to www.irs.gov/Form8038GC.

General Instructions Section references are to the Internal Revenue Code unless otherwise noted.

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.

Who Must File 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 Bonds.

Filing a separate return for a single issue.

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.

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 instructions for line 11, later.

Filing a consolidated return for multiple issues. For all tax-exempt governmental obligations with issue prices of less than $100,000 that aren’t 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, if the issue is a construction issue, 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.

For Paperwork Reduction Act Notice, see instructions. Cat. No. 64108B Form 8038-GC (Rev. 10-2021)

Form 8038-G (Rev. October 2021)

Department of the Treasury Internal Revenue Service

Information Return for Tax-Exempt Governmental Bonds ▶ Under Internal Revenue Code section 149(e)

▶ See separate instructions.

Caution: If the issue price is under $100,000, use Form 8038-GC.

▶ Go to www.irs.gov/F8038G for instructions and the latest information.

OMB No. 1545-0047

Part I Reporting Authority Check box if Amended Return ▶ 1 Issuer’s name 2 Issuer’s employer identification number (EIN)

3a Name of person (other than issuer) with whom the IRS may communicate about this return (see instructions) 3b Telephone number of other person shown on 3a

4 Number and street (or P.O. box if mail is not delivered to street address) Room/suite 5 Report number (For IRS Use Only)

6 City, town, or post office, state, and ZIP code 7 Date of issue

8 Name of issue 9 CUSIP number

10a Name and title of officer or other employee of the issuer whom the IRS may call for more information 10b Telephone number of officer or other employee shown on 10a

Part II Type of Issue (Enter the issue price.) See the instructions and attach schedule.

11 Education 12 Health and hospital 13 Transportation 14 Public safety 15 Environment (including sewage bonds) 16 Housing 17 Utilities 18 Other. Describe ▶ 18 19 a If bonds are TANs or RANs, check only box 19a . . . . . . . . . . . . . . . ▶ b If bonds are BANs, check only box 19b . . . . . . . . . . . . . . . . . . ▶ 20 If bonds are in the form of a lease or installment sale, check box . . . . . . . . . ▶

Part III Description of Bonds. Complete for the entire issue for which this form is being filed.

(a) Final maturity date (b) Issue price

(c) Stated redemption price at maturity

(d) Weighted average maturity

(e) Yield

$ $ years % Part IV Uses of Proceeds of Bond Issue (including underwriters’ discount) 22 Proceeds used for accrued interest 23 Issue price of entire issue (enter amount from line 21, column (b)) 24 Proceeds used for bond issuance costs (including underwriters’ discount) 24 25 Proceeds used for credit enhancement 26 Proceeds allocated to reasonably required reserve or replacement fund . 26 27 Proceeds used to refund prior tax-exempt bonds. Complete Part V . . . 27 28 Proceeds used to refund prior taxable bonds. Complete Part V 29 Total (add lines 24 through 28) 30 Nonrefunding proceeds of the issue (subtract line 29 from line 23 and enter amount here) . . . 30 Part V Description of Refunded Bonds. Complete this part only for refunding bonds.

31 Enter the remaining weighted average maturity of the tax-exempt bonds to be refunded . . . ▶ years 32 Enter the remaining weighted average maturity of the taxable bonds to be refunded . . . . ▶ years 33 Enter the last date on which the refunded tax-exempt bonds will be called (MM/DD/YYYY) . . ▶ 34 Enter the date(s) the refunded bonds were issued ▶ (MM/DD/YYYY)

For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 63773S Form 8038-G (Rev. 10-2021)