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Part III—Description of

principal, interest, or call premium on any

the conditions of the private business

other issue of bonds after 90 days of the

tests or the private loan financing test to

Obligations

date of issue, including proceeds that will

be met, then such issue is also an issue

Line 21. For column (a), the final

be used to fund an escrow account for

of private activity bonds. Regulations

maturity date is the last date the issuer

this purpose.

section 1.141-2(d)(3) defines a deliberate

must redeem the entire issue.

action as any action taken by the issuer

Part V—Description of

that is within its control regardless of

For column (b), see Issue price under

Refunded Bonds

whether there is intent to violate such

Definitions earlier.

Complete this part only if the bonds are to

tests. Regulations section 1.141-12

For column (c), the stated redemption

be used to refund a prior issue of

explains the conditions to taking remedial

price at maturity of the entire issue is the

tax-exempt bonds. For a lease or

action that prevent an action that causes

sum of the stated redemption prices at

installment sale, write “N/A” in the space

an issue to meet the private business

maturity of each bond issued as part of

to the right of the title for Part V.

tests or private loan financing test from

the issue. For a lease or installment sale,

being treated as a deliberate action.

Lines 31 and 32. The remaining

write “N/A” in column (c).

Check the box if the issuer has

weighted average maturity is determined

For column (d), the weighted average

established written procedures to ensure

without regard to the refunding. The

maturity is the sum of the products of the

timely remedial action for all nonqualified

weighted average maturity is determined

issue price of each maturity and the

bonds according to Regulations section

in the same manner as on line 21, column

number of years to maturity (determined

1.141-12 or other remedial actions

(d).

separately for each maturity and by taking

authorized by the Commissioner under

Line 34. If more than a single issue of

into account mandatory redemptions),

Regulations section 1.141-12(h).

bonds will be refunded, enter the date of

divided by the issue price of the entire

Line 44. Check the box if the issuer has

issue of each issue. Enter the date in an

issue (from line 21, column (b)). For a

established written procedures to monitor

MM/DD/YYYY format.

lease or installment sale, enter instead

compliance with the arbitrage, yield

the total number of years the lease or

Part VI—Miscellaneous

restriction, and rebate requirements of

installment sale will be outstanding.

section 148.

Line 35. An allocation of volume cap is

For column (e), the yield, as defined in

required if the nonqualified amount for the

Line 45a. Check the box if some part of

section 148(h), is the discount rate that,

issue is more than $15 million but is not

the proceeds was used to reimburse

when used to compute the present value

more than the amount that would cause

expenditures. Figure and then enter the

of all payments of principal and interest to

the issue to be private activity bonds.

amount of proceeds that are used to

be paid on the obligation, produces an

reimburse the issuer for amounts paid for

Line 36. If any portion of the gross

amount equal to the purchase price,

a qualified purpose prior to the issuance

proceeds of the issue is or will be

including accrued interest. See

of the bonds. See Regulations section

invested in a guaranteed investment

Regulations section 1.148-4 for specific

1.150-2.

contract (GIC), as defined in Regulations

rules to compute the yield on an issue. If

section 1.148-1(b), enter the amount of

the issue is a variable rate issue, write

Line 45b. An issuer must adopt an

the gross proceeds so invested, as well

“VR” as the yield of the issue. For other

official intent to reimburse itself for

as the final maturity date of the GIC and

than variable rate issues, carry the yield

preissuance expenditures within 60 days

the name of the provider of such contract.

out to four decimal places (for example,

after payment of the original expenditure

5.3125%). If the issue is a lease or

Line 37. Enter the amount of the

unless excepted by Regulations section

installment sale, enter the effective rate of

1.150-2(f). Enter the date the official

proceeds of this issue used to make a

interest being paid.

intent was adopted. See Regulations

loan to another governmental unit, the

section 1.150-2(e) for more information

interest of which is tax-exempt.

Part IV—Uses of Proceeds of

about official intent.

Line 38. If the issue is a loan of

Bond Issue

proceeds from another tax-exempt issue,

Signature and Consent

For a lease or installment sale, write “N/A”

check the box and enter the date of issue,

in the space to the right of the title for Part

An authorized representative of the issuer

EIN, and name of issuer of the master

IV.

must sign Form 8038-G and any

pool obligation.

applicable certification. Also print the

Line 22. Enter the amount of proceeds

Line 40. Check this box if the issue is a

name and title of the person signing Form

that will be used to pay interest from the

construction issue and an irrevocable

8038-G. The authorized representative of

date the bonds are dated to the date of

election to pay a penalty in lieu of

the issuer signing this form must have the

issue.

arbitrage rebate has been made on or

authority to consent to the disclosure of

Line 24. Enter the amount of the

before the date the bonds were issued.

the issuer’s return information, as

proceeds that will be used to pay bond

The penalty is payable with a Form

necessary to process this return, to the

issuance costs, including fees for trustees

8038-T for each 6-month period after the

person(s) that have been designated in

and bond counsel. If no bond proceeds

date the bonds are issued. Do not make

Form 8038-G.

will be used to pay bond issuance costs,

any payment of penalty in lieu of arbitrage

Note. If the issuer in Part 1, lines 3a and

enter zero. Do not leave this line blank.

rebate with this form. See Rev. Proc.

3b authorizes the IRS to communicate

Line 25. Enter the amount of the

92-22, 1992-1 C.B. 736 for rules

(including in writing and by telephone)

proceeds that will be used to pay fees for

regarding the “election document.”

with a person other than an officer or

credit enhancement that are taken into

Line 41a. Check this box if the issuer

other employee of the issuer, by signing

account in determining the yield on the

has identified a hedge on its books and

this form, the issuer’s authorized

issue for purposes of section 148(h) (for

records according to Regulations sections

representative consents to the disclosure

example, bond insurance premiums and

1.148-4(h)(2)(viii) and 1.148-4(h)(5) that

of the issuer’s return information, as

certain fees for letters of credit).

permit an issuer of tax-exempt bonds to

necessary to process this return, to such

Line 26. Enter the amount of proceeds

identify a hedge for it to be included in

person.

that will be allocated to such a fund.

yield calculations for computing arbitrage.

Paid Preparer

Line 27. Enter the amount of the

Line 42. In determining if the issuer has

proceeds that will be used to pay

super-integrated a hedge, apply the rules

If an authorized officer of the issuer filled

of Regulations section 1.148-4(h)(4). If

principal, interest, or call premium on any

in this return, the paid preparer’s space

the hedge is super-integrated, check the

other issue of bonds within 90 days of the

should remain blank. Anyone who

box.

date of issue.

prepares the return but does not charge

Line 28. Enter the amount of the

Line 43. If the issuer takes a “deliberate

the organization should not sign the

proceeds that will be used to pay

action” after the issue date that causes

return. Certain others who prepare the

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Instructions For Form 8038-G - Information Return For Tax-Exempt Governmental Obligations - Internal Revenue Service - 2011 Page 3

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