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Form 8038-G (Rev. 9-2011)
Page
Part VI
Miscellaneous
35
Enter the amount of the state volume cap allocated to the issue under section 141(b)(5) .
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36 a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract
(GIC) (see instructions)
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36a
b Enter the final maturity date of the GIC
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c Enter the name of the GIC provider
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37
Pooled financings: Enter the amount of the proceeds of this issue that are to be used to make loans
to other governmental units .
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38 a If this issue is a loan made from the proceeds of another tax-exempt issue, check box
and enter the following information:
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b Enter the date of the master pool obligation
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c Enter the EIN of the issuer of the master pool obligation
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d Enter the name of the issuer of the master pool obligation
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39
If the issuer has designated the issue under section 265(b)(3)(B)(i)(III) (small issuer exception), check box
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40
If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check box .
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41 a If the issuer has identified a hedge, check here
and enter the following information:
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b Name of hedge provider
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c Type of hedge
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d Term of hedge
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42
If the issuer has superintegrated the hedge, check box .
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If the issuer has established written procedures to ensure that all nonqualified bonds of this issue are remediated
43
according to the requirements under the Code and Regulations (see instructions), check box .
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44
If the issuer has established written procedures to monitor the requirements of section 148, check box .
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45a If some portion of the proceeds was used to reimburse expenditures, check here
and enter the amount
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of reimbursement .
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b Enter the date the official intent was adopted
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Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge
Signature
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 that I have authorized above.
and
Consent
Signature of issuer’s authorized representative
Date
Type or print name and title
Print/Type preparer’s name
Preparer's signature
Date
PTIN
Paid
Check
if
self-employed
Preparer
Use Only
Firm’s name
Firm's EIN
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Firm's address
Phone no.
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8038-G
Form
(Rev. 9-2011)