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Form 8038-G Information Return for Tax-Exempt Governmental Obligations
<br />(Rev. September tot t} - Under Internal Revenue Code section 149(e) OMB No, 1545-0720
<br />- See separate instructions.
<br />Department of the Treasury Caution: If the issue price !s under $100,000, use Form 8038-GG.
<br />internal Revenue Service -
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<br />iiirY~ie~._.~--r__Y,_~ -- r - - __ _ ,- ,.......
<br />1 Issuer's name ._____
<br />2 Issuer's employer identification number (EIN}
<br />3a Name of person {other than issuer) with whom the IRS may communicate about this return (see instructions)
<br />w... 3b Telephone number of other person shown on 3a
<br />_.. -....._. _ ._
<br />4 Number and street (or P,O, box if mail is not delivered to street address) Room/suite y)
<br />5 Report number (For 1R5 Use Onl
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<br />d....:~L...
<br />6 City, town, or post office state, and ZIP code 7 Date of issue
<br />8 Name of issue 9 CUSIPhumber
<br />10a Name and title of officer or other employee of the issuer whom the IRS may call for more information (sae tOb Telephone number of officer or other
<br />instructions) employee shown on 10a
<br />• Type of Issue (erfter the issue rice .See the instructions and attach schedule.
<br />w _ __ _
<br />.._.... _
<br />11 ..~
<br />, ,
<br />Education 11
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<br />12 .
<br />Health and hospital _ . . . _ 12 ~
<br />13 Transportation , , , _ 13
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<br />14 Public safety . 14 ~
<br />15 Environment (including sewage bonds) - . 15 .,,_~.
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<br />i6 Housing , , , , 16
<br />17 Utilities , , , 17
<br />18 Other. Describe - 18
<br />19 If ob-igations are TANs or RANs, check only box 19a
<br /> If obligations are BANs, check only box 19b , - ^
<br />20 if obligations are in the form of a lease or installment sale, check box , , - ^
<br />Description of Obligations. Comlete for the entire issue for which this form is being ffted__.
<br />a Final maturit date (b) Issue rice (c) Stated redemption (d) Weighted (e} Yield
<br />I J Y p ~ price at maturity average maturity
<br /> Uses of proceeds z~f and Is~de lnclu~liif~g underwriters' discount}
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<br />22 _M~.
<br />Proceeds used for accrued interest , ,
<br />22
<br />23 Issue price of entire issue (enter amount from line 21, column (b)) , 23
<br />24 Proceeds used for bond issuance costs (including underwriters' discount} . 24 _
<br />25 Proceeds used for credit enhancement 25
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<br />26 Proceeds allocated to reasonably required reserve or replacement fund 26
<br />27 Proceeds used to currently refund prior issues 27
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<br />28
<br />Proceeds used to advance refund prior issues
<br />28 __
<br />29 Total (add lines 24 through 28j , 29
<br />30 Nonrefunding proceeds of the issue (subtract line 29 from line 23 and enter amount h$r$) . 30
<br />• . Description of Refunded Bonds. Complete this zrt only for refunding bonds,
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<br />31
<br />32
<br />33
<br />34 Enter the remaining weighted average maturity of the bonds to be currently refunded . -
<br />Enter the remaining weighted average maturity of the bonds to be advance refunded , -
<br />Enter the last date on which the refunded bonds will be called (MM/DD/YYYY) , _ ~"
<br />Enter the date s the refunded bonds were. issued - ~1~vYxY} ears
<br />_____~years,_,
<br />,_„4_,, ~ .~.,.,.-e.
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<br />For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 637735 Form 8038-G (Rev. 9-2011)
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