Form   8038-R                              Request for Recovery of Overpayments 
(Rev. September 2017)                                Under Arbitrage Rebate Provisions                                                         OMB No. 1545-1750
                                             ▶ File a separate form for each issue.          ▶ See instructions. 
Department of the Treasury                         ▶ Go to www.irs.gov/Form8038R for the latest information.      
Internal Revenue Service 
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 in 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. 9-2017) 

Form 8038-R (Rev. 9-2017)                                                                                                                      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, the 
For the latest information about developments related to Form 8038-R,      IRS will contact the issuer or its representative to resolve the deficiency. 
such as legislation enacted after they were published, go to               If all the requested information isn’t timely received, a letter will be sent 
www.irs.gov/Form8038R.                                                     explaining that the request for recovery is deficient and that its 
                                                                           processing is rejected. 
What’s New                                                                 For refund claim denials, in full or in part, if the IRS makes a 
                                                                           preliminary determination to deny a refund claim, the IRS will notify the 
Claims for recovery of overpayments cannot be filed later than the date    issuer in writing that it may submit additional information or participate 
that is 2 years after (1) the date that is 60 days after the final         in a conference, or both. Additional information must be submitted 
computation date of the issue to which the payment relates; or (2) with    within 21 days of the request for additional information or the 
respect to the portion of the overpayment paid more than 60 days after     conference. If the issuer fails to submit additional information or if the 
the final computation date, the date that the payment was made to the      IRS disagrees that an overpayment occurred, the IRS will send the 
United States. See Rev. Proc. 2017-50, which is on page 234 of Internal    issuer a registered or certified letter denying the claim, subject to the 
Revenue Bulletin 2017-37 at www.irs.gov/pub/irs-irbs/irb17-37.pdf.         issuer's appeal rights. 
                                                                           The procedures for processing a request for refund are detailed in 
General Instructions                                                       Rev. Proc. 2008-37, which is on page 137 of Internal Revenue Bulletin 
Note: Use a separate Form 8038-R for each issue.                           2008-29 at www.irs.gov/pub/irs-irbs/irb08-29.pdf as modified by Rev. 
                                                                           Proc. 2017-50. 
Purpose of Form                                                            An issuer is entitled to appeal a refund claim denial. See Rev. Proc. 
Form 8038-R is used by issuers of state and local bonds to request a       2006-40, which is on page 694 of Internal Revenue Bulletin 2006-42 at 
refund of amounts paid with Form 8038-T, Arbitrage Rebate, Yield           www.irs.gov/pub/irs-irbs/irb06-42.pdf, for details.
Reduction, and Penalty in Lieu of Arbitrage Rebate. 
Payments made with Form 8038-T that may be recoverable include:            Where To File 
1. Yield reduction payments,                                               File Form 8038-R, and attachments, with the Internal Revenue Service, 
                                                                           Ogden Submission Processing Center, Ogden, UT 84201. 
2. The arbitrage rebate to the United States, 
                                                                           Private delivery services. Filers can use certain private delivery 
3. A penalty in lieu of rebating arbitrage to the United States, or        services (PDSs) designated by the IRS to meet the “timely mailing as 
4. A penalty to terminate the election to pay a penalty in lieu of         timely filing” rule for tax returns. Go to www.irs.gov/PDS for the current 
rebating arbitrage.                                                        list of designated services.
                                                                           The PDS can tell you how to get written proof of the mailing date.
Recovery of Overpayment                                                    For the IRS mailing address to use if you’re using a PDS, go to      
In general, an issuer may recover an overpayment of rebate for an issue    www.irs.gov/PDSstreetAddresses.
of bonds by establishing to the IRS that the overpayment occurred. An                 PDSs can’t deliver items to P.O. boxes. You must use the 
overpayment is the excess of the amount paid to the United States for                 U.S. Postal Service to mail any item to an IRS P.O. box 
an issue under section 148 over the sum of the rebate amount for the                  address.   
issue as of the most recent computation date and all amounts that are      ▲!
otherwise required to be paid under section 148 as of the date the         CAUTION
recovery is requested. 
An overpayment may be recovered only to the extent that a recovery         Specific Instructions 
on the date that it is first requested wouldn’t result in an additional    Line 1. Enter the name of the governmental entity that issued the  
rebate amount if that date were treated as a computation date.             bonds, not the name of the entity receiving the benefit of the financing. 
Except for overpayments of penalty in lieu of rebate under section  
148(f)(4)(C)(vii) and Regulations section 1.148-7(k), an overpayment of    Part I. Reporting Authority 
less than $5,000 may not be recovered before the final computation         Line 6. Enter the date of issue. This date should be identical to the date 
date. See Regulations section 1.148-3(i).                                  on the corresponding Form 8038-T, Part I, line 6. This is generally the 
The amount of rebate overpayment is based on the amount actually           first date on which there is a physical exchange of the bonds for the 
paid, not the future value of the amount paid.                             purchase price. 
Note:  Regulations section 1.148-3(b) provides that as of any date, the    Line 7. Enter the name of the issue. This name should be identical to the 
rebate amount for an issue is the excess of the future value, as of that   name listed on the corresponding Form 8038-T, Part I, line 7. If there is 
date, of all receipts on nonpurpose investments over the future value, as  no name, please provide other identification of the issue. 
of that date, of all payments on nonpurpose investments. The definitions   Line 8. Enter the CUSIP (Committee on Uniform Securities  
of payments and receipts in Regulations section 1.148-3(d), in part,       Identification Procedures) number of the bond with the latest maturity. 
require inclusion of transactions (including, but not limited to,          The CUSIP number should be identical to the CUSIP number listed on 
acquisition, earnings, and return of principal) on a date for each         the corresponding Form 8038-T, Part I, line 8. Enter “None” if the issue 
nonpurpose investment. Any cash flow representation to the contrary        doesn’t have a CUSIP number. 
may result in the understatement of rebate amount. Yield reduction         Lines 9 and 10. Enter the name, title, and telephone number of the 
payments are determined using payments and receipts as described in        officer of the issuer whom the IRS may call for more information. If the 
Regulations section 1.148-5(b)(1).                                         issuer designates a person other than an officer of the issuer (including 
Processing the Request                                                     a legal representative or paid preparer) whom the IRS may call for more 
                                                                           information with respect to this return, enter the name, title, and 
When filing Form 8038-R, you must provide:                                 telephone number of such person here.
• All copies of Form(s) 8038-T related to the request for refund, and      Note: By authorizing a person other than an authorized officer of the 
• The computations of the overpayment and interest (if any) on line 17.    issuer to communicate with the IRS and whom the IRS may call for 
The computations must show all cash flows from the issue date to the       more information with respect to this return, the issuer authorizes the 
computation date reflecting the overpayment (for example, if a series of   IRS to communicate directly with the individual listed in line 9 and 
reports were prepared, all such reports must be provided, unless the       consents to the disclosure of the issuer’s return information to that 
last report details all cash flows). Provide any additional attachments if individual, as necessary, in order to process this return.
needed. 

Form 8038-R (Rev. 9-2017)                                                                                                                            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 
                                                                            complying with these laws. 
Line 20. The final computation date is the date the issue is discharged. 
For details, see Regulations section 1.148-3(e)(2).                           You are not required to provide the information requested on a form 
                                                                            that is subject to the Paperwork Reduction Act unless the form displays 
Line 21. Enter the name and EIN of an entity, other than a governmental     a valid OMB control number. Books or records relating to a form or its 
entity, that is to use proceeds of these obligations. If more than one,     instructions must be retained as long as their contents may become 
attach a schedule.                                                          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             The time needed to complete and file this form will vary depending  
person.                                                                     on individual circumstances. The estimated average time is:  
Note: By authorizing a person other than an authorized officer of the       Recordkeeping, 5 hr., 30 min.; Learning about the law or the form,   
issuer to communicate with the IRS and whom the IRS may contact with        3 hr., 16 min.; Preparing, copying, assembling, and sending the form 
respect to this return, the issuer authorizes the IRS to communicate        to the IRS, 3 hr., 30 min. 
directly with the individual entered in line 22 and consents to disclose      We welcome your comments about this form and instructions and 
the issuer's return information to that individual, as necessary, in order  your suggestions for future editions.
to process this return.
                                                                              You can send us comments from www.irs.gov/FormComments. 
Signature and Consent                                                         Or you can write to:
An authorized representative of the issuer must sign Form 8038-R and          Internal Revenue Service                                                                    
any applicable certification. Also print the name and title of the person     Tax Forms and Publications                                                             
signing Form 8038-R.                                                          1111 Constitution Ave. NW, IR-6526                                     
                                                                              Washington, DC 20224
The authorized representative of the issuer signing this form must 
have the authority to consent to the disclosure of the issuer's return        We respond to many letters by telephone. Therefore it would be 
information, including information provided on the issuer's                 helpful if you would include your daytime phone number, including the 
corresponding Form 8038-T, as necessary to process this return, to the      area code, in your correspondence.
person(s) that have been designated in Form 8038-R.                           Although we cannot respond individually to each comment received, 
Note: If authority is granted in line 9 or line 22 for the IRS to           we do appreciate your feedback and will consider your comments as we 
communicate with a person other than an officer of the issuer, by           revise our tax products. 
signing this form, the issuer's authorized representative consents to the     Do not send the form to this address. Instead, see Where To File, 
disclosure of issuer's return information, as necessary to process this     earlier. 
return, to such person.