Form  8038-R                           Request for Recovery of Overpayments 
(Rev. October 2021)                                  Under Arbitrage Rebate Provisions                                                         OMB No. 1545-0047
                                         ▶
Department of the Treasury                          File a separate form for each issue.          ▶ See instructions. 
Internal Revenue Service                           ▶ Go to www.irs.gov/Form8038R for the latest information.      
Part I    Reporting Authority 
1  Issuer’s name                                                                                                     2  Issuer’s employer identification number (EIN)

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

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

7  Name of issue                                                                                                     8  CUSIP number 

9  Name and title of officer of the issuer or other person whom the IRS may call for more information                10  Telephone number of officer or other person 

Part II   Request for Refund of Amounts Paid Under Rebate Provisions (see instructions) 
11       If the issue was outstanding on or prior to June 30, 1993, and the issuer elects                    not   to apply the 1992 regulations, check 
         here. See instructions . .    .           . .  .  . .   . .          . . . . .  . .          . . .      . . . . . . .        .      .  . . .   .  ▶
12       Total amount paid under rebate provisions  .            . .          . . . . .  . .          . . .      . . . . . . .               12 
13       Rebate amount as of the most recent computation date                     . . .  . .          . .    13 
14       Amounts (not included on line 12) required to be paid under section 148 as of
         the date the recovery is requested             .  . .   . .          . . . . .  . .          . .    14 
15       Add lines 13 and 14  .   .    .           . .  .  . .   . .          . . . . .  . .          . . .      . . . . . . .               15 
16       Amount of overpayment. Subtract line 15 from line 12  .                  . . .  . .          . . .      . . . . . . .               16 
17       Computations and relevant facts that led to overpayment (see instructions). Attach additional sheets if necessary. 

18       Schedule of payments (see instructions). Attach additional sheets if necessary. 

Part III  Other Information  (see instructions)                             Check the “Yes” or “No” box for each question below.                        Yes  No 

19       Was the overpayment paid as penalty in lieu of rebate under section 148(f)(4)(C)(vii)?  .                   . . . . .        .  ▶          19 

20       Has the final computation date for the issue occurred?  .                . . .  . .          . . .      . . . . . . .        .  ▶          20 
21       If  an  entity  other  than  a  governmental  entity  is  to  use  proceeds  of  these  obligations,  enter  the  name  and  EIN  of  that 
         organization. If more than one, attach schedule.
         Name ▶                                                                                         EIN ▶
22       If the issuer wishes to authorize the IRS to communicate directly with a person who is a representative of the entity listed on
         line 21, check the box and enter the name and telephone number of such person.
         Name ▶                                                                                         Phone no. 
          Under penalties of perjury, I declare that I have examined this request for recovery of overpayment, including accompanying schedules and statements, and 
          to the best of my knowledge and belief, the facts represented in support of the request are true, correct, and complete. I further declare that I consent to the 
Signature IRS’s disclosure of the issuer’s return information, as necessary to process this return, to the persons that I have authorized on lines 9 and 22 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  ▶
            Firm’s address  ▶                                                                                            Phone no.
For Paperwork Reduction Act Notice, see the instructions.                                  Cat. No. 57334H                            Form 8038-R (Rev. 10-2021) 

Form 8038-R (Rev. 10-2021)                                                                                                                      Page 2 
Section references are to the Internal Revenue Code unless otherwise       Generally, this information will be sufficient to determine whether a 
noted.                                                                     refund is appropriate. For refund claim rejections where there is a 
                                                                           procedural deficiency or where an issuer has failed to provide sufficient 
Future Developments                                                        information to enable a determination that an overpayment occurred, 
For the latest information about developments related to Form 8038-R,      the IRS will contact the issuer or its representative to resolve the 
such as legislation enacted after it was published, go to                  deficiency. If all the requested information isn’t timely received, a letter 
www.irs.gov/Form8038R.                                                     will be sent explaining that the request for recovery is deficient and that 
                                                                           its processing is rejected. 
                                                                           For refund claim denials, in full or in part, if the IRS makes a 
General Instructions                                                       preliminary determination to deny a refund claim, the IRS will notify the 
Note: Use a separate Form 8038-R for each issue.                           issuer in writing that it may submit additional information or participate 
                                                                           in a conference, or both. Additional information must be submitted 
Purpose of Form                                                            within 21 days of the request for additional information or the 
Form 8038-R is used by issuers of state and local bonds to request a       conference. If the issuer fails to submit additional information or if the 
refund of amounts paid with Form 8038-T, Arbitrage Rebate, Yield           IRS disagrees that an overpayment occurred, the IRS will send the 
Reduction, and Penalty in Lieu of Arbitrage Rebate.                        issuer a registered or certified letter denying the claim, subject to the 
                                                                           issuer’s appeal rights. 
Payments made with Form 8038-T that may be recoverable include: 
                                                                           The procedures for processing a request for refund are detailed in 
1. Yield reduction payments,                                               Rev. Proc. 2008-37, which is on page 137 of Internal Revenue Bulletin 
2. The arbitrage rebate to the United States,                              2008-29 at www.irs.gov/pub/irs-irbs/irb08-29.pdf, as modified by Rev. 
3. A penalty in lieu of rebating arbitrage to the United States, or        Proc. 2017-50. 
4. A penalty to terminate the election to pay a penalty in lieu of         An issuer is entitled to appeal a refund claim denial. See Rev. Proc. 
rebating arbitrage.                                                        2021-10, which is on page 503 of Internal Revenue Bulletin 2021-4 at 
                                                                           www.irs.gov/pub/irs-irbs/irb21-04.pdf, for details.
Recovery of Overpayment 
                                                                           Where To File 
In general, an issuer may recover an overpayment of rebate for an issue 
of bonds by establishing to the IRS that the overpayment occurred. An      File Form 8038-R, and attachments, with the Internal Revenue Service, 
overpayment is the excess of the amount paid to the United States for      Ogden Submission Processing Center, Ogden, UT 84201. 
an issue under section 148 over the sum of the rebate amount for the       Private delivery services. Filers can use certain private delivery 
issue as of the most recent computation date and all amounts that are      services (PDSs) designated by the IRS to meet the “timely mailing as 
otherwise required to be paid under section 148 as of the date the         timely filing” rule for tax returns. Go to www.irs.gov/PDS for the current 
recovery is requested.                                                     list of designated services.
Note: Claims for recovery of overpayments cannot be filed later than the   The PDS can tell you how to get written proof of the mailing date.
date that is 2 years after (1) the date that is 60 days after the final    For the IRS mailing address to use if you’re using a PDS, go to      
computation date of the issue to which the payment relates; or (2) with    www.irs.gov/PDSstreetAddresses.
respect to the portion of the overpayment paid more than 60 days after 
the final computation date, the date that the payment was made to the                 PDSs can’t deliver items to P.O. boxes. You must use the 
United States. See Rev. Proc. 2017-50, which is on page 234 of Internal               U.S. Postal Service to mail any item to an IRS P.O. box 
Revenue Bulletin 2017-37 at www.irs.gov/pub/irs-irbs/irb17-37.pdf.         ▲!         address.   
                                                                           CAUTION
An overpayment may be recovered only to the extent that a recovery 
on the date that it is first requested wouldn’t result in an additional 
rebate amount if that date were treated as a computation date.             Specific Instructions 
Except for overpayments of penalty in lieu of rebate under section         Line 1. Enter the name of the governmental entity that issued the  
148(f)(4)(C)(vii) and Regulations section 1.148-7(k), an overpayment of    bonds, not the name of the entity receiving the benefit of the financing. 
less than $5,000 may not be recovered before the final computation  
date. See Regulations section 1.148-3(i).                                  Part I. Reporting Authority 
The amount of rebate overpayment is based on the amount actually           Line 6. Enter the date of issue. This date should be identical to the date 
paid, not the future value of the amount paid.                             on the corresponding Form 8038-T, Part I, line 6. This is generally the 
Note:  Regulations section 1.148-3(b) provides that as of any date, the    first date on which there is a physical exchange of the bonds for the 
rebate amount for an issue is the excess of the future value, as of that   purchase price. 
date, of all receipts on nonpurpose investments over the future value, as  Line 7. Enter the name of the issue. This name should be identical to the 
of that date, of all payments on nonpurpose investments. The definitions   name listed on the corresponding Form 8038-T, Part I, line 7. If there is 
of payments and receipts in Regulations section 1.148-3(d), in part,       no name, please provide other identification of the issue. 
require inclusion of transactions (including, but not limited to,          Line 8. Enter the CUSIP (Committee on Uniform Securities  
acquisition, earnings, and return of principal) on a date for each         Identification Procedures) number of the bond with the latest maturity. 
nonpurpose investment. Any cash flow representation to the contrary        The CUSIP number should be identical to the CUSIP number listed on 
may result in the understatement of rebate amount. Yield reduction         the corresponding Form 8038-T, Part I, line 8. Enter “None” if the issue 
payments are determined using payments and receipts as described in        doesn’t have a CUSIP number. 
Regulations section 1.148-5(b)(1).                                                         Enter the name, title, and telephone number of the 
                                                                           Lines 9 and 10. 
Processing the Request                                                     officer of the issuer whom the IRS may call for more information. If the 
                                                                           issuer designates a person other than an officer of the issuer (including 
When filing Form 8038-R, you must provide:                                 a legal representative or paid preparer) whom the IRS may call for more 
• All copies of Form(s) 8038-T related to the request for refund, and      information with respect to this return, enter the name, title, and 
• The computations of the overpayment and interest (if any) on line 17.    telephone number of such person here.
The computations must show all cash flows from the issue date to the       Note: By authorizing a person other than an authorized officer of the 
computation date reflecting the overpayment (for example, if a series of   issuer to communicate with the IRS and whom the IRS may call for 
reports were prepared, all such reports must be provided, unless the       more information with respect to this return, the issuer authorizes the 
last report details all cash flows). Provide any additional attachments if IRS to communicate directly with the individual listed on line 9 and 
needed.                                                                    consents to the disclosure of the issuer’s return information to that 
                                                                           individual, as necessary, in order to process this return.

Form 8038-R (Rev. 10-2021)                                                                                                                      Page 3 

Part II. Request for Refund                                                 Paid Preparer  
Line 11. Current Regulations sections 1.148-1 through 1.148-11 apply        If an authorized representative of the issuer filled in its return, the paid 
to issues outstanding after June 30, 1993. If the issue was outstanding     preparer’s space should remain blank. Anyone who prepares the return 
prior to July 1, 1993, the 1992 regulations apply (that is, Regulations     but doesn’t charge the organization shouldn’t sign the return. Certain 
sections 1.148-1 through 1.148-12, effective May 18, 1992 (T.D. 8418,       others who prepare the return shouldn’t sign. For example, a regular, 
1992-1 C.B. 29)). However, check the box if the issue was outstanding       full-time employee of the issuer, such as a clerk, secretary, etc., 
prior to July 1, 1993, and the issuer has elected not to apply the 1992     shouldn’t sign.
regulations; the current Regulations sections 1.148-1 through 1.148-11      Generally, anyone who is paid to prepare a return must sign it and fill 
apply.                                                                      in the other blanks in the Paid Preparer Use Only area of the return.
Line 17. Provide the computations of the overpayment paid as part of a      The paid preparer must:
rebate payment, penalty in lieu of rebate, or to terminate the penalty in   • Sign the return in the space provided for the preparer’s signature (a 
lieu of rebate. Also, include the computations for interest (if any). A     facsimile signature is acceptable),
description of the facts that led to the overpayment must be included on 
this form.                                                                  • Enter the preparer information, and 
Line 18. Provide a schedule showing amounts and dates that payments         • Give a copy of the return to the issuer.
were made to the United States for the issue. Attach copies of Form(s) 
8038-T that accompanied payments to the United States.                      Paperwork Reduction Act Notice. We ask for the information on this 
                                                                            form to carry out the Internal Revenue laws of the United States. You 
Part III. Other Information                                                 are required to give us the information. We need it to ensure that you are 
Line 20. The final computation date is the date the issue is discharged.    complying with these laws.
For details, see Regulations section 1.148-3(e)(2).                         You are not required to provide the information requested on a form 
Line 21. Enter the name and EIN of an entity, other than a governmental     that is subject to the Paperwork Reduction Act unless the form displays 
entity, that is to use proceeds of these obligations. If more than one,     a valid OMB control number. Books or records relating to a form or its 
attach a schedule.                                                          instructions must be retained as long as their contents may become 
                                                                            material in the administration of any Internal Revenue law. Generally, tax 
Line 22. If the issuer wishes to authorize the IRS to communicate           returns and return information are confidential, as required by section 
directly with a person who is a representative of the entity listed on line 6103.
21, check the box and enter the name and telephone number of such 
person.                                                                     The time needed to complete and file this form will vary depending on 
                                                                            individual circumstances. The estimated burden for tax-exempt 
Note: By authorizing a person other than an authorized officer of the       organizations filing this form is approved under OMB control number 
issuer to communicate with the IRS and whom the IRS may contact with        1545-0047 and is included in the estimates shown in the instructions for 
respect to this return, the issuer authorizes the IRS to communicate        their information return.
directly with the individual entered on line 22 and consents to disclose 
the issuer’s return information to that individual, as necessary, in order  Comments and suggestions. If you have comments concerning the 
to process this return.                                                     accuracy of this time estimate or suggestions for making this form 
                                                                            simpler, we would be happy to hear from you. You can send us 
Signature and Consent                                                       comments from www.irs.gov/FormComments. Or you can write to: 
                                                                            Internal Revenue Service, Tax Forms and Publications Division, 1111 
An authorized representative of the issuer must sign Form 8038-R and        Constitution Ave. NW, IR-6526, Washington, DC 20224.
any applicable certification. Also print the name and title of the person 
signing Form 8038-R.                                                        Do not send the form to this address. Instead, see Where To File, 
                                                                            earlier.
The authorized representative of the issuer signing this form must 
have the authority to consent to the disclosure of the issuer's return 
information, including information provided on the issuer’s 
corresponding Form 8038-T, as necessary to process this return, to the 
person(s) that has been designated on Form 8038-R.
Note: If authority is granted on line 9 or line 22 for the IRS to 
communicate with a person other than an officer of the issuer, by 
signing this form, the issuer’s authorized representative consents to the 
disclosure of the issuer’s return information, as necessary to process 
this return, to such person.