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Page 1 of 6                                                                                                     Instructions for Form 8038-TC                                                                                                                                                                                                                                                                                                                                                                                    11:48 -  9-JUN-2010

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 Department of the Treasury
Instructions for Form                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Internal Revenue Service

8038-TC

(June 2010)

Information Return for Tax Credit Bonds and Specified Tax Credit Bonds

Section references are to the Internal                                                                                                                                                                                                 more information on specified tax credit                                                                                                                                                                                                     completed based on the facts as of the
Revenue Code unless otherwise noted.                                                                                                                                                                                                   bonds see Notice 2010-35.                                                                                                                                                                                                                    issue date.
                                                                                                                                                                                                                                       Note.                  Only issuers of specified tax credit                                                                                                                                                                                    For specified tax credit bonds, Form
General Instructions                                                                                                                                                                                                                   bonds that qualify for and have elected to                                                                                                                                                                                                   8038-TC must be filed at least 30 days
                                                                                                                                                                                                                                       receive a refundable credit under section                                                                                                                                                                                                    prior to the submission of the first Form
What’s New                                                                                                                                                                                                                             6431(f) may file Form 8038-CP. If the                                                                                                                                                                                                        8038-CP, Return for Credit Payments to
The American Recovery and                                                                                                                                                                                                              issuer of a specified tax credit bond                                                                                                                                                                                                        Issuers of Qualified Bonds, that is filed to
Reinvestment Act of 2009 added qualified                                                                                                                                                                                               makes the election under section 6431(f),                                                                                                                                                                                                    request payment with respect to an
school construction bonds and                                                                                                                                                                                                          the holder of the bond will not be eligible                                                                                                                                                                                                  interest payment date for that issue.
consolidated those bonds together with                                                                                                                                                                                                 to receive a tax credit under section 54A.                                                                                                                                                                                                   Failure to complete this form, including
qualified forestry conservation bonds,                                                                                                                                                                                                     Other tax credit bonds, including                                                                                                                                                                                                        the attached schedules may result in a
qualified zone academy bonds, qualified                                                                                                                                                                                                qualified forestry conservation bonds,                                                                                                                                                                                                       delay in processing this form. All attached
energy conservation bonds, and new                                                                                                                                                                                                     clean renewable energy bonds, and                                                                                                                                                                                                            schedules must include the issuer’s name
clean renewable energy bonds under                                                                                                                                                                                                     Midwestern tax credit bonds, are not                                                                                                                                                                                                         and EIN at the top.

sectionholders54Aof suchthatbonds.allows a tax credit to the                                                                                                                                                                           undereligiblesectionto elect6431(f).to receive direct payments                                                                                                                                                                               LateextensionfilingofAntimeissuerto filemayFormbe8038-TCgranted an
Section 301 of P.L. 111-147 (H.R.                                                                                                                                                                                                      Purpose of Form                                                                                                                                                                                                                              under section 3 of Rev. Proc. 2002-48,

maybonds,andEmployment2847),issuersbonds,qualifiedelectthequalifiedqualifiedof newtoHiringapply(HIRE)schoolcleanenergyzoneIncentivessectionconstructionAct,renewableacademyconservationprovides6431(f)to Restorebonds,energybondsthattoFormspecified149(e).theunderwithqualifiedthe8038-TCWhoinformationtaxMusttaxcreditiscreditFileusedbondsrequired, tobondsbyprovidethelistedbyandissuersbelowsectionthe IRSof                                                                   form,Formneglect.2002-37Formtheof Rev.failure“Request8038-TC8038-TCProc.TypeI.R.B.to file2002-48.”orfor531,wasatimelyprintletterReliefnotifatitexplainingisfiledisAttachtheundernotdeterminedtoponduesectiontotime.oftowhythethewillfulAlsothat3
receive a refundable credit in lieu of tax                                                                                                                                                                                             Who Must File–Qualified Tax                                                                                                                                                                                                                  indicate whether the bond issue in
credits under section 54A (specified tax                                                                                                                                                                                               Credit Bonds                                                                                                                                                                                                                                 question is under examination by the IRS.
creditcredit bonds).bonds electIssuersunderof specifiedsection 6431(f)tax                                                                                                                                                              separateIssuers ofFormthe following8038-TCbondsfor eachmusttaxfile a                                                                                                                                                                         indentureDo not submitor othercopiesbondofdocuments.the trust
to receive a refundable credit in lieu of tax                                                                                                                                                                                          credit bond issue issued after March                                                                                                                                                                                                         Note.               If Form 8038-TC is filed late for
credits under section 54A. For qualified                                                                                                                                                                                               2010.                                                                                                                                                                                                                                        specified tax credit bonds, it still must be
school construction bonds and qualified                                                                                                                                                                                                •   Qualified forestry conservation bonds,                                                                                                                                                                                                   filed 30 days prior to the submission of
zone academy bonds the amount of the                                                                                                                                                                                                   •   New clean renewable energy bonds,                                                                                                                                                                                                        the first Form 8038-CP for that issue.
refundable credit allowed is equal to the                                                                                                                                                                                              •   Qualified energy conservation bonds,
lesser of:                                                                                                                                                                                                                             •   Qualified zone academy bonds,                                                                                                                                                                                                            Where To File
1. the amount of interest payable                                                                                                                                                                                                      •   Qualified school construction bonds,                                                                                                                                                                                                     File Form 8038-TC and any attachments
under such bond on such date, or                                                                                                                                                                                                       •   Clean renewable energy bonds,                                                                                                                                                                                                            with Department of the Treasury, Internal
2. the amount of interest which would                                                                                                                                                                                                  •   Midwestern tax credit bonds, and                                                                                                                                                                                                         Revenue Service Center, Ogden, UT
have been payable under such bond on                                                                                                                                                                                                   •   All other qualified tax credit bonds                                                                                                                                                                                                     84201.

suchdetermineddetermineddate ifatundersuchtheinterestapplicablesectionwere54A(b)(3).credit rate                                                                                                                                        Bonds(exceptInformationshouldandbebuildreportedRecoveryReturnAmericaforonZonebondsBuildFormEconomicAmerica8038-B,which                                                                                                                       Privatedesignatedcertain privatedeliveryby thedeliveryservices.IRS toservicesmeetYouthecan“timelyuse
For qualified energy conservation bonds                                                                                                                                                                                                Development Bonds).                                                                                                                                                                                                                          mailing as timely filing/paying” rule for tax
and new clean renewable energy bonds,                                                                                                                                                                                                                                                                                                                                                                                                                                               returns and payments. These private
the amount of the refundable credit                                                                                                                                                                                                    Who Must File–Specified Tax                                                                                                                                                                                                                  delivery services include only the
allowed is equal to the lesser of:                                                                                                                                                                                                     Credit Bonds                                                                                                                                                                                                                                 following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    •

whichwereundersuchrate2.1.determinedbonddeterminedthe70%wouldsuchamountofonbondhavethesuchunderamountatonofbeendatetheinterestsuchsectionapplicablepayableifofdate,suchinterestpayable54A(b)(3).orinterestundercredit                  ••••bondcredit8038-TCIssuersQualifiedNewQualifiedQualifiedissue.bondscleanoffortheenergyzoneschooleachmustrenewablefollowingacademyspecifiedfileconstructionconservationaspecifiedseparateenergybonds,tax creditbonds.bonds,bonds,taxFormand ••InternationalOvernight,InternationalPriorityService.UnitedFederalDHL ExpressOvernight,ParcelExpressFedExPriority,First.(DHL):Service2Day,FedEx(FedEx):andDHL(UPS):FedExFedExStandardSameFedExUPSDayNext
For specified tax credit bonds with                                                                                                                                                                                                                                                                                                                                                                                                                                                 Day Air, UPS Next Day Air Saver, UPS
multiple bond maturities, the refundable                                                                                                                                                                                               When To File                                                                                                                                                                                                                                 2nd Day Air, UPS 2nd Day Air A.M., UPS
credit payment is determined separately                                                                                                                                                                                                File Form 8038-TC on or before the 15th                                                                                                                                                                                                      Worldwide Express Plus, and UPS
with respect to each maturity. See the                                                                                                                                                                                                 day of the 2nd calendar month after the                                                                                                                                                                                                      Worldwide Express.
instruction for line 5, Part II. Specified tax                                                                                                                                                                                         close of the calendar quarter in which the                                                                                                                                                                                                     The private delivery service can tell
credit bonds are treated as qualified                                                                                                                                                                                                  bond was issued. Form 8038-TC may not                                                                                                                                                                                                        you how to get written proof of the mailing
bonds for purposes of section 6431. For                                                                                                                                                                                                be filed before the issue date and must be                                                                                                                                                                                                   date.
                                                                                                                                                                                                                                                                                                                      Cat. No. 54164P



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Page 2 of 6                                          Instructions for Form 8038-TC                                                                                                                                                                                                                   11:48 -  9-JUN-2010

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Other Forms That May Be                                                                                                             percent or more of the proceeds of which                                                                                       “Amended Return” box in the heading of
Required                                                                                                                            are to be used for capital expenditures                                                                                        the form.

rebateFormFor submitting8038-T,to the FederalArbitragepaymentGovernmentRebate,of arbitrageYielduse                                  incurredprojectsmore eligibleasbydefinedqualifiedclean renewableinborrowerssection 54.energyfor one or                         thereturn,Theinformationinamendedadditionreportedreturnto themustnewon theorprovideoriginalcorrectedall
Reduction and Penalty in Lieu of                                                                                                    New clean renewable energy bond.                                                                               An              information. Attach an explanation of the
Arbitrage Rebate. For reporting build                                                                                               obligation that is part of an issue 100                                                                                        reason for the amended return and write
America bonds, both tax credit and direct                                                                                           percent of the available project proceeds                                                                                      across the top, “Amended Return
pay, including recovery zone economic                                                                                               of which are to be used for capital                                                                                            Explanation.”
development bonds, use Form 8038-B.                                                                                                 expenditures incurred by governmental                                                                                          Line 1.            Enter the name of the entity

creditreceivebondsForfromwhoissuersa directtheelectofFederalpaymentunderspecifiedGovernment,sectionoftaxa refundablecredit6431 totheasmorecooperativebodies,definedqualifiedpublicinelectricsectionpowerrenewablecompaniesproviders,54C.energyfororfacilitiesone orissuingfinancing.Lineentity2.receivingtheAnbonds,issuerthenotthatbenefitthedoesnameofnotthehaveof thean
payment must be requested on Form                                                                                                   Qualified energy conservation bond.                                                                                            employer identification number (EIN)
8038-CP. Each Form 8038-CP can only                                                                                                 An obligation that is part of an issue 100                                                                                     should apply for one on Form SS-4,
relate to the interest paid on a single bond                                                                                        percent of the available project proceeds                                                                                      Application for Employer Identification
issue. Issuers of specified tax credit                                                                                              of which are to be used for one or more                                                                                        Number. You can get this form on the IRS
bonds with multiple maturities must file a                                                                                          qualified energy conservation purposes                                                                                         website at www.irs.gov or by calling
separate Form 8038-CP for each                                                                                                      as defined in section 54D.                                                                                                     1-800-TAX-FORM (1-800-829-3676). You
maturity.                                                                                                                           Midwestern tax credit bond.                                                        An                                          may receive an EIN by telephone by
                                                                                                                                    obligation that is part of an issue of bonds                                                                                   following the instructions for Form SS-4.
Rounding to Whole Dollars                                                                                                           issued in connection with Midwestern                                                                                           Line 3.             If the issuer wishes to authorize
You should report the money items on                                                                                                disaster areas in any state in which a                                                                                         a person other than an officer of the
this return as whole dollars. To do so,                                                                                             Midwestern disaster area is located. See                                                                                       issuer (including a legal representative or
drop amounts less than 50 cents and                                                                                                 section 1400N(l) for more information                                                                                          paid preparer) to communicate with the
increase amounts from 50 cents through                                                                                              about these requirements.                                                                                                      IRS and whom the IRS may contact with
99 cents to the next higher dollar.                                                                                                 Issue.       Generally, bonds are treated as                                                                                   respect to this return (including in writing
Questions on Filing Form                                                                                                            byparttheofsamethe sameissuer,issueonifthetheysamearedate,issued                                                               orpersonby telephone),here. Theenterpersonthelistednameinoflinesuch3
8038-TC                                                                                                                             and in a single transaction, or series of                                                                                      must be an individual. Do not enter the
For specific questions on how to file Form                                                                                          related transactions.                                                                                                          name and title of an officer of the issuer
8038-TC send an email to the IRS at                                                                                                 Issue price.                     The issue price of                                                                            here (use line 10 for that purpose).
TaxExemptBondQuestions@irs.gov                                                                                                      obligations is generally determined under                                                                                      Note.        By authorizing a person other
and put “Form 8038-TC Questions” in the                                                                                             Regulations section 1.148-1(b). Thus,                                                                                          than an authorized officer of the issuer to
subject line. In the email include a                                                                                                when issued for cash, the issue price is                                                                                       communicate with the IRS and whom the
description of your question, a return                                                                                              the price at which a substantial amount of                                                                                     IRS may contact with respect to this
email address, the name of a contact                                                                                                the obligations are sold to the public. To                                                                                     return, the issuer authorizes the IRS to
person, and a telephone number.                                                                                                     determine the issue price of an obligation                                                                                     communicate directly with the individual
Definitions                                                                                                                         issuedand 1274forandproperty,the relatedsee sectionsincome1273tax                                                              theenteredissuer’sin linereturn3 andinformationconsents totodisclosethat
Tax credit bond.                                     An obligation issued                                                           regulations.                                                                                                                   individual, as necessary, in order to
under sections 54, 54A, or 1400N(l) that                                                                                            Sale proceeds.                                  Sale proceeds are                                                              process this return.
entitles the taxpayer holding such bond                                                                                             determined under Regulations section                                                                                           Line 4.            This line is for IRS Use Only. Do
on one or more credit allowance dates                                                                                               1.148-1(b) as any amount actually or                                                                                           not make any entries in the boxes.

imposedoccurringcredit againstforduringthattheanytaxablefederaltaxableyear.incomeyeartaxto a                                        theunderwriters’constructivelyissue, includingdiscountreceivedamountsorfromcompensationtheusedsaletoofpay                      Lines(includingperson5otheranda legal6.than Ifrepresentativeanyouofficerlistedofinthelineorissuerpaid3 a
Qualified forestry conservation bond.                                                                                               and accrued interest, other than                                                                                               preparer) to communicate with the IRS
An obligation that is part of an issue 100                                                                                          pre-issuance accrued interest. Sale                                                                                            and whom the IRS may contact with
percent of the available project proceeds                                                                                           proceeds also include, but are not limited                                                                                     respect to this return, enter the number
of which are to be used to finance one or                                                                                           to, amounts derived from the sale of a                                                                                         and street (or P.O. Box if mail is not
more qualified forestry conservation                                                                                                right that is associated with a bond, and                                                                                      delivered to the street address) and city,
purposes as defined in section 54B.                                                                                                 that is described in Regulations section                                                                                       town, or post office, state, and ZIP code
Qualified zone academy bond.                                                                   An                                   1.148-4(b)(4). Sale proceeds shall also                                                                                        of that person. Otherwise, enter the
obligation that is part of an issue 100                                                                                             include the proceeds from the sale of                                                                                          issuer’s number and street (or P.O. Box if
percent of the available project proceeds                                                                                           credit strips. See also Regulations section                                                                                    mail is not delivered to the street address)
of which are to be used for a qualified                                                                                             1.148-4(h)(5) treating amounts received                                                                                        and city, town, or post office, state, and
purpose with respect to a qualified zone                                                                                            upon the termination of certain hedges as                                                                                      ZIP code.
academy established by an eligible local                                                                                            sale proceeds.                                                                                                                 Line 7.            The date of issue is generally the
education agency as provided in section                                                                                             Arbitrage.                     The issuer must comply with                                                                     date on which the issuer exchanges the
54E.                                                                                                                                the arbitrage requirements of sections                                                                                         bonds for the underwriter’s (or other
Qualified school construction bond.                                                                                                 148 and 54A.                                                                                                                   purchaser’s) funds.
An obligation that is part of an issue 100                                                                                                                                                                                                                         Line 8.            If there is no name of the issue,
percent of the available project proceeds                                                                                           Specific Instructions                                                                                                          please provide other identification of the
of which are to be used for the                                                                                                                                                                                                                                    issue.
construction, rehabilitation, or repair of a                                                                                        Part I—Reporting Authority                                                                                                     Line 9.            Enter the Committee on Uniform
public school facility or for the acquisition                                                                                       Amended return.                                 An issuer may file an                                                          Securities Identification Procedures
of land on which such a facility is to be                                                                                           amended return to change or add to the                                                                                         (CUSIP) number of the latest maturity on
constructed with the proceeds as set forth                                                                                          information reported on a previously filed                                                                                     line 9. Attach a schedule with a complete
in section 54F.                                                                                                                     return for the same date of issue. If you                                                                                      list of CUSIP numbers for each bond. If
Clean renewable energy bond.                                                                   An                                   are filing to correct errors or change a                                                                                       some or all of the tax credits are stripped,
obligation that is part of an issue 95                                                                                              previously filed return, check the                                                                                             attach a schedule with the name of each
                                                                                                                                                                                    -2-



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Page 3 of 6                                                                                                          Instructions for Form 8038-TC                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    11:48 -  9-JUN-2010

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

purchaser of the tax credit bonds or tax                                                                                                                                                                                                                                                                       date, and the earliest date that the bonds                                                                                                                                                                                                                                                                                          knows the interest amount for a certain
credit strips, each purchaser’s EIN, and                                                                                                                                                                                                                                                                       can be called.                                                                                                                                                                                                                                                                                                                      period, for that period the issuer should
the CUSIP numbers associated with the                                                                                                                                                                                                                                                                              Determining the refundable credit                                                                                                                                                                                                                                                                                               provide the refundable credit payment
bonds and the stripped tax credits. If the                                                                                                                                                                                                                                                                     payment under section 6431(f) for                                                                                                                                                                                                                                                                                                   expected to be requested from the IRS as
issue does not have a CUSIP number,                                                                                                                                                                                                                                                                            specified tax credit bonds with a single                                                                                                                                                                                                                                                                                            allowed under section 6431(f).
write, “None.” If the issue either has no                                                                                                                                                                                                                                                                      maturity. For QZABs or QSCBs, the
CUSIP number or is privately placed,                                                                                                                                                                                                                                                                           amount of refundable credit payment with                                                                                                                                                                                                                                                                                            Note.                 If the bond issue reported on this
attach a schedule with each purchaser’s                                                                                                                                                                                                                                                                        respect to an interest payment date is                                                                                                                                                                                                                                                                                              Form 8038-TC constitutes both fixed rate
EIN, name, and address.                                                                                                                                                                                                                                                                                        equal to the lesser of the amount of                                                                                                                                                                                                                                                                                                bonds and variable bonds, a separate
Line 10.                                        Enter the name and title of the                                                                                                                                                                                                                                interest payable on such bond on the                                                                                                                                                                                                                                                                                                schedule must be entered for each of the
officer of the issuer whom the IRS may                                                                                                                                                                                                                                                                         interest payment date or 100% of the                                                                                                                                                                                                                                                                                                bonds.
call for more information. If the issuer                                                                                                                                                                                                                                                                       amount of interest which would have                                                                                                                                                                                                                                                                                                 Part III—Description of
otherenteredthanin linean officer3 the nameof theofissuera person                                                                                                                                                                                                                                              beeninterestpayablepaymentunderdatesuchif thebondintereston thewere                                                                                                                                                                                                                                                                 Obligations
(including a legal representative or paid                                                                                                                                                                                                                                                                      determined at the applicable credit rate                                                                                                                                                                                                                                                                                            Line 1.                      See issue price under Definitions
preparer) to communicate with the IRS                                                                                                                                                                                                                                                                          determined under section 54A(b)(3). For                                                                                                                                                                                                                                                                                             on page 2.
and whom the IRS may contact with                                                                                                                                                                                                                                                                              new CREBs and QECBs, the amount of                                                                                                                                                                                                                                                                                                  Line 2.                      The stated redemption price at
respect to this return (including in writing                                                                                                                                                                                                                                                                   refundable credit payment with respect to                                                                                                                                                                                                                                                                                           maturity of the entire issue is the sum of
or by telephone), leave line 10 blank.                                                                                                                                                                                                                                                                         an interest payment date is equal to the                                                                                                                                                                                                                                                                                            the stated redemption prices at maturity
Line 11.                                        Enter the telephone number of                                                                                                                                                                                                                                  lesser of the amount of interest payable                                                                                                                                                                                                                                                                                            of each bond issued as part of the issue.
the person whom the IRS may contact for                                                                                                                                                                                                                                                                        on such bond on the interest payment                                                                                                                                                                                                                                                                                                Line 3.                      Enter the last date on which any
more information identified in line 3 or line                                                                                                                                                                                                                                                                  date or 70% of the amount of interest                                                                                                                                                                                                                                                                                               of the bonds will mature. If more than one
10, as applicable.                                                                                                                                                                                                                                                                                             which would have been payable under                                                                                                                                                                                                                                                                                                 maturity, attach a schedule for each
                                                                                                                                                                                                                                                                                                               such bond on the interest payment date, if                                                                                                                                                                                                                                                                                          principal payment date.
Part II—Type of Issue                                                                                                                                                                                                                                                                                          the interest were determined at theapplicable credit rate determined under                                                                                                                                                                                                                                                          Line 4.                      The applicable credit rate is the
Line 1.                           Identify the type of tax credit                                                                                                                                                                                                                                              section 54A(b)(3).                                                                                                                                                                                                                                                                                                                  daily rate set by the Secretary under
bonds issued by entering the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       section 54A(b)(3) determined as of the
corresponding three digit code as follows:                                                                                                                                                                                                                                                                         Determining the refundable credit                                                                                                                                                                                                                                                                                               first day on which there is a binding,
• 101 - Qualified forestry conservation                                                                                                                                                                                                                                                                        payment under section 6431(f) for                                                                                                                                                                                                                                                                                                   written contract for the sale or exchange
bonds,                                                                                                                                                                                                                                                                                                         specified tax credit bonds with multiple                                                                                                                                                                                                                                                                                            of the bond. Carry the percent out to two
• 102 - New clean renewable energy                                                                                                                                                                                                                                                                             maturities. The refundable credit payment                                                                                                                                                                                                                                                                                           decimal places, do not round (for
bonds,                                                                                                                                                                                                                                                                                                         for specified tax credit bonds with multiple                                                                                                                                                                                                                                                                                        example, 10.74%). Such a rate is posted
• 103 - Qualified energy conservation                                                                                                                                                                                                                                                                          maturities is determined separately for                                                                                                                                                                                                                                                                                             by the Bureau of Public Debt on its
bonds,                                                                                                                                                                                                                                                                                                         each bond maturity by comparing the                                                                                                                                                                                                                                                                                                 internet site for State and Local
• 104 - Qualified zone academy bonds,                                                                                                                                                                                                                                                                          interest payable on each bond maturity                                                                                                                                                                                                                                                                                              Government Series securities at www.
• 105 - Qualified school construction                                                                                                                                                                                                                                                                          with the interest that would have been                                                                                                                                                                                                                                                                                              treasurydirect.gov. See Notice 2009-15
bonds,                                                                                                                                                                                                                                                                                                         payable on such bond maturity if the                                                                                                                                                                                                                                                                                                which is on page 449 of Internal Revenue
• 106 - Clean renewable energy bonds,                                                                                                                                                                                                                                                                          interest on such bond maturity were                                                                                                                                                                                                                                                                                                 Bulletin 2009-6 at www.irs.gov/pub/
• 107 - Midwestern tax credit bonds, and                                                                                                                                                                                                                                                                       calculated using the applicable credit rate                                                                                                                                                                                                                                                                                         irs-irbs/irb09-06.pdf.

•LineirrevocableLine1083.2.- Other.EnterIf theelectionissuertype oftohasbond.applymadesectionan                                                                                                                                                                                                                andofmaturitymaturity.amountstwosummingbondwithForwithmaturities,anexample,respectupinterestthe lessertoifonerateeachanofwithissueofbondthe2%aconsiststwo2-yearand                                                                                                                                                                  LinetheapplicablethewhichyearSecretary5.theout Entertaxduringtocreditundertwotheeachdecimalmaximumbondssectioncalendarareplaces,54A(d)(5)termsold.monthsetdoCarrybynotin
6431(f) check “Yes,” if not, check “No.” If                                                                                                                                                                                                                                                                    one with a 15-year maturity with an                                                                                                                                                                                                                                                                                                 round. Enter zeroes in the last two
“No,” skip lines 4 and 5.                                                                                                                                                                                                                                                                                      interest rate of 6%, while the applicable                                                                                                                                                                                                                                                                                           positions (for example, 10.00). The

thelastthebonds.date.Line8038-CPgovernmentalon whichquarterlydateinterest4.An(ForinEnterinterestinterestforanvariablepaymenttheperiodissuerMM/DD/YYYYtheissuepaymentisfirstpayableforratetodatewillinterestwhichtheissues,relate.)dateapplicableholdersbyformat.thepaymenttheisenterfirsttheEnteroftodatethethetherespectbeisnewamountbondcreditinterestof5%,thetheinterestCREBsmaturity.rate2-yearthesumthattothatallowableinterestaswereofwouldequalsorbondoftheIfQECBs,thethecalculatedamountpaymenthavematurity5%salerefundableissueofthebeendatethattheisanddateamountusinganof15-yearpayableequalscreditissuethethe1thewouldissueofof2%withifunderpermittedandmaximumPublicpercentatexpectedLinewww.treasurydirect.gov.Local6.sectionDebtoutEntertoyieldtermGovernmenttoonbe54A(d)(4)(C).fourtheforitsusedis postedinternettheapplicabledecimaltosinkingSeriesrepaybysiteplaces,CarrythemaximumthefundsecuritiesforBureauissueStatethedo notof
Line 5.                           Check the box indicating the                                                                                                                                                                                                                                                 applicable credit rate would be calculated                                                                                                                                                                                                                                                                                          round. Enter zeroes in the last two
interest payment date frequency. In                                                                                                                                                                                                                                                                            by reducing the interest that would be                                                                                                                                                                                                                                                                                              positions (for example, 10.7400%). The
addition, issuers of specified tax credit                                                                                                                                                                                                                                                                      payable by multiplying such interest by                                                                                                                                                                                                                                                                                             permitted sinking fund yield is set by the
bonds must attach a debt service                                                                                                                                                                                                                                                                               .70 (70%) with respect to each bond                                                                                                                                                                                                                                                                                                 Secretary consistent with the maximum
schedule to the Form 8038-TC which                                                                                                                                                                                                                                                                             maturity. In the example above, the                                                                                                                                                                                                                                                                                                 term determined under section 54A(d)(5)
contains the information described below                                                                                                                                                                                                                                                                       refundable credit payment with respect to                                                                                                                                                                                                                                                                                           and is posted by the Bureau of Public
for the bond issue.                                                                                                                                                                                                                                                                                            interest payment date 1 for the 2-year                                                                                                                                                                                                                                                                                              Debt on its internet site for State and

complete1. For fixed-ratedebt servicebonds,scheduleattachtitleda                                                                                                                                                                                                                                               maturitymaturity wouldwould bebe 2%3.5%andof thefor theoutstanding15-year                                                                                                                                                                                                                                                           Localwww.treasurydirect.gov.Government Series securities at
“Fixed Rate Bond–Debt Service                                                                                                                                                                                                                                                                                  bond maturity.                                                                                                                                                                                                                                                                                                                      Line 7.                      For specified tax credit bonds
Schedule” that provides a list of each                                                                                                                                                                                                                                                                               2. For variable rate bonds, attach a                                                                                                                                                                                                                                                                                          enter the interest rate on the bonds and
interest payment date, the total interest                                                                                                                                                                                                                                                                      debt service schedule titled “Variable                                                                                                                                                                                                                                                                                              carry the interest rate out to four decimal
payable on such date, the total principal                                                                                                                                                                                                                                                                      Rate Bond–Debt Service Schedule” that                                                                                                                                                                                                                                                                                               places. For specified tax credit bonds with
amount of bonds expected to be                                                                                                                                                                                                                                                                                 provides a list of each interest payment                                                                                                                                                                                                                                                                                            more than one maturity, enter the interest
outstanding on such date, the interest                                                                                                                                                                                                                                                                         date, the total principal amount of bonds                                                                                                                                                                                                                                                                                           rate of the latest maturity. If the issue is a
rate, the refundable credit payment                                                                                                                                                                                                                                                                            expected to be outstanding on such date,                                                                                                                                                                                                                                                                                            variable rate issue, leave blank.
expected to be requested from the IRS as                                                                                                                                                                                                                                                                       and a description of how interest on the                                                                                                                                                                                                                                                                                            Line 8.                      For specified tax credit bonds, if
allowed under section 6431(f) on such                                                                                                                                                                                                                                                                          bonds is computed. However, if the issuer                                                                                                                                                                                                                                                                                           the issue is a variable rate issue, check
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Page 4 of 6                                                              Instructions for Form 8038-TC                                                                                                                                                                                                                                                                                      11:48 -  9-JUN-2010

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

the box on 8a. Enter the frequency that                                                                                                                                                     Line 14.                      Enter total qualified purpose                                                                                              Line 2.                            The issuer must certify that
rates are reset on line 8b.                                                                                                                                                                 expenditures equal to the sum of amounts                                                                                                                 applicable state and local law
                                                                                                                                                                                            entered in lines 1a through 13.                                                                                                                          requirements governing conflicts of
Part IV—Proceeds of Issue                                                                                                                                                                   Line 15.                      To determine the percentage of                                                                                             interest are satisfied with respect to the
Line 1.           See Sale proceeds, under                                                                                                                                                  total proceeds to be used for qualified                                                                                                                  bond issue. See section 54A(d)(6). If
Definitions on page 2.                                                                                                                                                                      purpose expenditures, divide line 14 in                                                                                                                  these requirements are met, check the

lineNote.1 mustIf theincludebond issalestrippedproceedsat issuance,of the                                                                                                                   Partthe resultV by byline100.7 in Part IV, then multiply                                                                                                 boxLinein3.lineIf some2.                                         or all of the tax credits
principal and sale proceeds of the credit                                                                                                                                                   Line 16.                      Determine the proceeds of the                                                                                              are stripped, check the box.
strips.                                                                                                                                                                                     issue used to reimburse the issuer for                                                                                                                   Note.               Submit the information required
                                                                                                                                                                                            amounts paid for a qualified purpose prior                                                                                                               under Part I, line 9.
Line 2.           Enter the amount of the                                                                                                                                                   to the issuance of the bonds. See
proceeds that will be used to pay bond                                                                                                                                                      Regulations section 1.150-2.                                                                                                                             Line 4.                            If an issuer fails to spend 100

issuancefees, feescosts,for trustees,includingandunderwriter’sbond counsel.                                                                                                                 Lineunder17.RegulationsSubject tosectioncertain1.150-2(f),exceptionsan                                                                                   expenditurepercentof the issueof thebyperiodavailablethe close(includingprojectof theany3-yearproceeds
Note.             Bond issuance costs for tax credit                                                                                                                                        issuer must adopt an official intent, as                                                                                                                 extensions granted), the issuer must
bonds issued under section 54A are                                                                                                                                                          described in Regulations section                                                                                                                         redeem all of the nonqualified bonds
limited to 2 percent of sale proceeds.                                                                                                                                                      1.150-2(e), to reimburse itself for                                                                                                                      within 90 days after the end of such

proceedsLineissue,issuer3.includingfromEstimateonthethesaleproceedssaleexpectedofproceedstaxreceivedcreditsinvestmentofthattheby the                                                        Enterafterpreissuanceadopted.paymentthe dateexpendituresofthetheofficialoriginalintentwithinexpenditure.was60 days                                       expenditurechecktheproceduresissuerthe box.hastoperiod.meetestablishedSeethis requirement,54A(d)(2)(B).written                             If
have been stripped from the bonds.                                                                                                                                                          Part VI—Allocation of National,                                                                                                                          Line 5.                            “Other” is reserved for future tax
Line 4.           For all tax credit bonds issued                                                                                                                                           State, Tribal, or Local Bond                                                                                                                             credit bonds.
under section 54A expected available                                                                                                                                                        Limitation Amount                                                                                                                                        Signature and Consent
project proceeds shall be calculated by                                                                                                                                                     Line 1a.                      Enter the amount of volume cap                                                                                              An authorized issuer representative must
subtracting line 2 from line 1 and adding                                                                                                                                                   allocated to the issue by bond type.                                                                                                                     sign Form 8038-TC and any applicable
line 3.                                                                                                                                                                                     Attach a copy of the national (for                                                                                                                       certification. The authorized
  For Midwestern tax credit bonds (Code                                                                                                                                                     example, from the Department of the                                                                                                                      representative of the issuer signing this
107) and for clean renewable energy                                                                                                                                                         Treasury or IRS), state, tribal, or local                                                                                                                form must have the authority to consent
bonds (Code 106) read line 4 by                                                                                                                                                             allocations with respect to the issue.                                                                                                                   to the disclosure of the issuer’s return
substituting “proceeds” for “available                                                                                                                                                      Check the tribal box if the allocation is                                                                                                                information, as necessary to process this
project proceeds,” add lines 1 and 3, and                                                                                                                                                   provided by the Department of Interior.                                                                                                                  return, to the person(s) that have been
enter that amount on line 4. Do not                                                                                                                                                         Failure to attach the appropriate                                                                                                                        designated in Form 8038-TC.
subtract line 2, bond issuance cost.                                                                                                                                                        allocation certification will result in a delay                                                                                                          Note.               If line 3 authorizes the IRS to

matchinginsertLine 5.theForfunds.amountMidwesternof statetaxpledgedcredit bonds,                                                                                                            officialsinqualifiedbeenprocessingdesignatedmusttax creditcertifythisasform.bonds.thatoneThetheorOnmoreappropriateissuethetypesblankhas         of       officerthetelephone)communicateissuer’sof thewithauthorizedissuer,(includinga personby signingrepresentativeinotherwritingthisthanandform,anby
Line 6.           Enter any amount of proceeds                                                                                                                                              line below 1a enter the year of allocation                                                                                                               consents to the disclosure of issuer’s
not otherwise itemized in lines 1-5 and                                                                                                                                                     and, if applicable, the amount of                                                                                                                        return information, as necessary to
describe the purpose for which the                                                                                                                                                          carryforward allocation.                                                                                                                                 process this return, to such person.
proceeds are to be used.                                                                                                                                                                    Lines 1b through 1d.                                                                     Check the
Line 7.           Total proceeds equal the sum of                                                                                                                                           corresponding box indicating whether the                                                                                                                 Paid Preparer
lines 4 through 6.                                                                                                                                                                          allocation is national, local, state, or tribal.                                                                                                         If an authorized officer of the issuer filled
                                                                                                                                                                                            Line 2.               If the allocation is from a state,                                                                                                 in this return, the paid preparer’s space
Note.             For Midwestern tax credit bonds                                                                                                                                           enter the state abbreviation.                                                                                                                            should remain blank. Anyone who
matching pledged funds are included in                                                                                                                                                                                                                                                                                                               prepares the return but does not charge
total proceeds for the purpose of                                                                                                                                                           Part VII—Miscellaneous                                                                                                                                   the organization should not sign the

wellexpenditures.accounteddeterminingtocreditbeasusedbondsbondforforthematchingproceedsThus,inqualifiedpercentagePartforV.pledgedmustpurposeMidwesternForofqualifiedbeproceedsfundstaxtaxas expected54A(d)(4)(C)LinereserveLine 1b.1a.fundtoCheckArepayreservedescribed(sinkingthethemayboxfund)issueinifbesectiontherethatatfundedmaturity.isis ain returnregular,notreturn.suchsign.asshouldCertainfull-timea clerk,nototherssecretary,employeesign.whoForprepareetc.,example,of theshouldissuer,thea
credit bonds issued under section 54A,                                                                                                                                                      unequal periodic installments so long as it                                                                                                                Generally, anyone who is paid to
lines 4 and 7, available project proceeds                                                                                                                                                   is funded no sooner than in equal periodic                                                                                                               prepare a return must sign it and fill in the
and total proceeds, respectively, should                                                                                                                                                    installments. Check the box if the reserve                                                                                                               other blanks in the Paid Preparer’s Use
equal the same amount.                                                                                                                                                                      fund is funded no sooner than in equal                                                                                                                   Only area of the return. The paid preparer
                                                                                                                                                                                            periodic payments.                                                                                                                                       must:
Part V—Description of Use of                                                                                                                                                                Line 1c.                      Check the box if either the                                                                                                • Sign the return in the space provided
Proceeds for Qualified Purpose                                                                                                                                                              reserve fund is expected to result in an                                                                                                                 for the preparer’s signature,
                                                                                                                                                                                                                                                                                                                                                     •
Expenditures                                                                                                                                                                                amount greater than the amountnecessary to repay the issue or if the                                                                                     • Enter the preparer information, andGive a copy of the return to the issuer.
Lines 1a through 12.amount of proceeds allocated to eachEnter the dollar                                                                                                                    yield on the reserve fund is greater thanthe permitted sinking fund yield (entered                                                                       Part VIII—Consent to
qualified purpose expenditure on the                                                                                                                                                        in Part III, line 6).                                                                                                                                    Disclosure of Certain
corresponding line.                                                                                                                                                                         Line 1d.                      For purposes of monitoring the                                                                                             Information From This Return
Line 13.                  Enter the dollar amount of                                                                                                                                        arbitrage requirements of section 148,                                                                                                                   Line 1.                            If the issuer consents to the
proceeds allocated to each qualified                                                                                                                                                        such monitoring shall include the                                                                                                                        IRS’s publication, through a website or
purpose expenditure not otherwise                                                                                                                                                           arbitrage requirements of section 54A. If                                                                                                                other publication, of its name and
itemized in lines 1a through 12 and                                                                                                                                                         the issuer has established such written                                                                                                                  address, employer identification number,
describe the use of proceeds.                                                                                                                                                               procedures, check the box.                                                                                                                               name and description of bond issue, date
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Page 5 of 6                                                               Instructions for Form 8038-TC                                                                                                                                                                                                                                                                                                                                                                                             11:48 -  9-JUN-2010

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

of issuance, CUSIP numbers, issue price,                                                                                                                                                            Line 9.                      A new CREB must be                                                                                                                                                                                             Part II
final maturity date, stated redemption                                                                                                                                                              designated as such by a qualified issuer.                                                                                                                                                                                                   For IRS use only. Do not make an entry in
price at maturity, applicable credit rate                                                                                                                                                           If these bonds have been designated as                                                                                                                                                                                                      line 1.
and maximum term to assist in the proper                                                                                                                                                            new CREBs, check “Yes.” See section
reporting of interest, tax credits, or other                                                                                                                                                        54C(a) for more information.                                                                                                                                                                                                                Part III—List of Conservation
benefits under section 6049, check the                                                                                                                                                                                                                                                                                                                                                                                                          Purposes, Location of the
box next to “Yes.”                                                                                                                                                                                  Part II                                                                                                                                                                                                                                     Facilities, Amount of Proceeds
Note.                         Part VIII does not apply to issuers                                                                                                                                   For IRS use only. Do not make an entry in                                                                                                                                                                                                   Used for the Purpose, Private
of tax credit bonds that have electeddirect payment refundable credits under                                                                                                                        line 1.                                                                                                                                                                                                                                     Activity User and Private User’s
section 6431(f).                                                                                                                                                                                    Part III—List of Qualified                                                                                                                                                                                                                  EIN
                                                                                                                                                                                                    Renewable Energy Facilities                                                                                                                                                                                                                 Line 1.               Eligible issuers of QECBs
Schedule A. New Clean                                                                                                                                                                                                                                                                                                                                                                                                                           include states, political subdivisions as
                                                                                                                                                                                                    Line 1.                      A “Qualified Renewable Energy                                                                                                                                                                                  defined for purposes of section 103, and
Renewable Energy Bonds                                                                                                                                                                              Facility” means a qualified facility as                                                                                                                                                                                                     entities empowered to issue bonds on
(New CREBs) Under                                                                                                                                                                                   determined under section 45(d) (withoutregard to paragraphs (8) and (10) and to                                                                                                                                                             behalf of any such entity under rulessimilar to those for determining whether a
Sections 54A and 54C                                                                                                                                                                                any placed in service date) owned by a                                                                                                                                                                                                      bond issued on behalf of a state or
                                                                                                                                                                                                    public power provider, a governmental                                                                                                                                                                                                       political subdivision constitutes an
Part I—Issuer Questions                                                                                                                                                                             body, or a cooperative electric company.                                                                                                                                                                                                    obligation of that state or political

LinepublicFederalLineutilityterms1.2.witharepowerPowerAAdefinedacooperativepublicserviceprovider,Act.powerinIfobligationsectionthecheckelectricproviderissuer217“Yes.”ascompanyisofissuchathea statemorebonds,energyowner(s)andListproceedsthethethanthefacilitytypeamountoftoonelocationthebeoftofacility,qualifiedusedfacility,ofbeavailableoffinancedfortheattachtherenewablethatfacility,owner’sprojectfacility.bya schedule.)thetheEIN,(If andsubdivisioneligible1.150-1(b)).(asFurther,definedRegulationsissuerseligibleforin Regulationspurposesinissuerssectionconduitinclude1.103-1(b).offinancingsectionsectionotherwise103issues
is a mutual or cooperative electric                                                                                                                                                                                                                                                                                                                                                                                                             List each type of qualified conservation
company described in section 501(c)(12)                                                                                                                                                                                                                                                                                                                                                                                                         purpose described under section 54D(f)
or section 1381(a)(2)(c). If the issuer is a                                                                                                                                                        Schedule B. Qualified                                                                                                                                                                                                                       to be financed by the bonds, the location
cooperative“Yes.”                              electric company, check                                                                                                                              Energy Conservation                                                                                                                                                                                                                         amountof the facilityof available(if applicable),project proceedsand the                                                                                                 to
Line 3.                              A governmental body is any                                                                                                                                     Bonds (QECBs) Under                                                                                                                                                                                                                         be used for each qualified conservation
political subdivision thereof. If the issuerstate or Indian tribal government, or any                                                                                                               Sections 54A and 54D                                                                                                                                                                                                                        bonds, provide the name and EIN of thepurpose. If the bonds are private activity
is a governmental body, check “Yes.”                                                                                                                                                                Part I—Issuer and Project                                                                                                                                                                                                                   private user(s). (If more than onepurpose, facility, owner, or user, attach
Line 4.                              A clean renewable energy bond                                                                                                                                  Questions                                                                                                                                                                                                                                   schedule.)
lender is a lender which is a cooperative
owned by, or has outstanding loans to,                                                                                                                                                              Line 1.                      A QECB must be designated as
100 or more cooperative electric                                                                                                                                                                    such by the issuing state or local                                                                                                                                                                                                          Schedule C. Qualified
companies and was in existence onFebruary 1, 2002, and shall include any                                                                                                                            government. See section 54D(a). If thesebonds have been designated as QECBs,                                                                                                                                                                Zone Academy Bonds
affiliated entity which is controlled by such                                                                                                                                                       check “Yes.”                                                                                                                                                                                                                                (QZABs) Under Sections
lender. If the issuer is a clean renewable                                                                                                                                                          Line 2.                      Section 54D(e)(2)(B) provides                                                                                                                                                                                  54A and 54E
energy bond lender, check “Yes.”                                                                                                                                                                    that the amount allocated to a large local
Line 5.                              If the issuer is a not-for-profit                                                                                                                              government may, if unused, be                                                                                                                                                                                                               Part I—Academy and Issuer
electric utility which has received a loan                                                                                                                                                          reallocated by such local government to                                                                                                                                                                                                     Information

ElectrificationexceptLineor loan6.inguaranteeNoticelimitedAct,2009-33circumstancesunderchecktheprovides“Yes.”Ruralinvolvingthat,                                                                    isonthefromlocated.anstateaallocationlargeinIfwhichlocalthe bondsthatgovernmentsuchhasarelocalbeenissuedgovernmenttoreallocatedabasedstate,                                                                                                 “Yes.”designatedLine 1.If theempowermentschool is locatedzone,inchecka
reimbursements to which section                                                                                                                                                                     check “Yes.”                                                                                                                                                                                                                                Line 2.               If the school is located in a
54A(d)(2)(D) applies, costs of acquiring                                                                                                                                                                                                                                                                                                                                                                                                        designated enterprise community, check
existing facilities generally will be treated                                                                                                                                                       Line 3.                      A large local government means                                                                                                                                                                                 “Yes.”
as nonqualified costs. If any of the                                                                                                                                                                any municipality or county if such                                                                                                                                                                                                          Line 5.               If for any calendar year the
available project proceeds have been                                                                                                                                                                municipality or county has a population of                                                                                                                                                                                                  allocation for a state exceeds the amount
used to acquire existing facilities, check                                                                                                                                                          100,000 or more. If the issuer is a large                                                                                                                                                                                                   of bonds issued for such year, the
“Yes.”                                                                                                                                                                                              local government, check “Yes.”                                                                                                                                                                                                              limitation may be carried over but only to
Line 7.                              Notice 2009-33 provides that                                                                                                                                   Line 6.                      If the issuer issued the bonds                                                                                                                                                                                 the first 2 years following the year in
refinancing costs (as contrasted with                                                                                                                                                               based on a volume cap allocation                                                                                                                                                                                                            which the unused limitation arose.
costs of enhancements, repair or                                                                                                                                                                    received by another authorized entity                                                                                                                                                                                                       Limitation amounts are treated on a
rehabilitation of existing facilities),                                                                                                                                                             (that allocated volume cap to the issue),                                                                                                                                                                                                   first-in, first-out basis. If the bonds or any
generally will be treated as nonqualified                                                                                                                                                           check “Yes.” If not, check “No.” If yes is                                                                                                                                                                                                  portion of the bonds are issued under a
costs. If any of the available project                                                                                                                                                              checked, provide the name of such                                                                                                                                                                                                           carryover limitation, check “Yes” and
proceeds have been used to refinance                                                                                                                                                                authorized entity. If more than one                                                                                                                                                                                                         enter the year in which the limitation
existing facilities, check “Yes.”                                                                                                                                                                   authorized entity allocated volume cap to                                                                                                                                                                                                   arose.
Line 8.                              Notice 2009-33 provides that an                                                                                                                                the bond issue, attach a schedule listing                                                                                                                                                                                                   Line 7.               In order for a bond to be a
allocation of new CREB volume cap                                                                                                                                                                   the names of, and amount of bonds for,                                                                                                                                                                                                      “qualified zone academy bond,” the issuer
limitation is valid for 3 years after the date                                                                                                                                                      each such authorized entity. If the box on                                                                                                                                                                                                  must certify that it has written
of the letter issuing the allocation (the                                                                                                                                                           line 6 is checked “Yes,” failure to insert                                                                                                                                                                                                  commitments from private entities to
“volume cap allocation date”). If the issue                                                                                                                                                         the name of the other authorized entity                                                                                                                                                                                                     make qualified contributions having a
date of the issue is on or before 3 years                                                                                                                                                           that allocated volume cap to the issue                                                                                                                                                                                                      present value (as of the date of issuance
after the volume cap allocation date,                                                                                                                                                               may result in a delay in processing the                                                                                                                                                                                                     of the issue) of not less than 10% of the
check “Yes.”                                                                                                                                                                                        return.                                                                                                                                                                                                                                     proceeds of the issue. If the eligible local
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Page 6 of 6                                                                                              Instructions for Form 8038-TC                                                                                                                                                                                                                                                                                                                                                                                                                                         11:48 -  9-JUN-2010

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

educational agency that established the                                                                                                                                                                                                                                         contribution. (If more than 5 donors,                                                                                                                                                                                                         Privacy Act and Paperwork Reduction
qualified zone academy has received                                                                                                                                                                                                                                             attach a schedule.)                                                                                                                                                                                                                           Act Notice.                                      We ask for the information
such written commitments, check “Yes.”                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        on this form to carry out the Internal
Line 9.               A QZAB must be designated as                                                                                                                                                                                                                              Schedule D. Qualified                                                                                                                                                                                                                         Revenue laws of the United States. You
governmentsuch by the issuingwithin thestatejurisdictionor local                                                                                                                          where                                                                                 School Construction                                                                                                                                                                                                                           Weare requiredneed it totoensuregive usthattheyouinformation.are
the school is located. If these bonds have                                                                                                                                                                                                                                      Bonds (QSCBs) Under                                                                                                                                                                                                                           complying with these laws. Section 6109
been designated as QZABs, check “Yes.”                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        requires paid preparers to provide their
See section 54E(a)(3) for more                                                                                                                                                                                                                                                  Sections 54A and 54F                                                                                                                                                                                                                          identifying number.
information.                                                                                                                                                                                                                                                                    Part I— Use of Proceeds                                                                                                                                                                                                                       You are not required to provide the
Line 10.                               Write in the name of the local                                                                                                                                                                                                                                                                                                                                                                                                                                                         information requested on a form that is
education agency. Failure to provide the                                                                                                                                                                                                                                        Line 1.                   An Indian school is a school                                                                                                                                                                                        subject to the Paperwork Reduction Act
name of the eligible education agency                                                                                                                                                                                                                                           funded by the Bureau of Indian Affairs.                                                                                                                                                                                                       unless the form displays a valid OMB
may result in a delay in processing the                                                                                                                                                                                                                                         Line 3.                   A QSCB must be designated as                                                                                                                                                                                        control number. Books or records relating
return.                                                                                                                                                                                                                                                                         such by the issuing state or local                                                                                                                                                                                                            to a form or its instructions must be
                                                                                                                                                                                                                                                                                government. See section 54F(a). If these                                                                                                                                                                                                      retained as long as their contents may
Part II—Description of the                                                                                                                                                                                                                                                      bonds have been designated as QSCBs,                                                                                                                                                                                                          become material in the administration of
Private Business Contribution                                                                                                                                                                                                                                                   check “Yes.”                                                                                                                                                                                                                                  any Internal Revenue law. Generally, tax

businessLines 1 throughcontributions4.                                                                     Qualifiedunder sectionprivate                                                                                                                                        Part II                                                                                                                                                                                                                                       returnsconfidential,and returnas requiredinformationby sectionare                                                                               6103.
54E(d)(4)the qualifiedare:zone(a) equipmentacademy (includingfor use in                                                                                                                                                                                                         lineFor IRS1.             use only. Do not make an entry in                                                                                                                                                                                   thisTheformtimewillneededvary dependingto completeon individualand file
state-of-the-art technology and vocational                                                                                                                                                                                                                                      Part III— Issuer Information                                                                                                                                                                                                                  circumstances. The estimated average

classroom;volunteeroutsideequipment);developingteachersmarkettrips, ordriventheotherinmentors;(c)curriculumorderacademy(b)educationaltechnologyservicestechnicalto(d)promotefororinternships,ofstudents;inassistanceinopportunitiesemployeestrainingtheappropriateorfieldin(e)asIfthethewhicheducationthanLinetheproceedsnameone1.issuertheIflocalofpublicagencytheissuchwillissuerissuingeducationalschoolbelocalinusedtheisbondseducationnotfacilityjurisdictionisagency,thelocated,forforlocalmoreagency.whichattachofenterformPreparing,assembling,RecordkeepingLearningtimeformis:to.................theaboutcopying,IRSand..........the.........sendinglaw orthethe 2215hr.,hr.,hr.,25163min.min.min.
any other property or service specified by                                                                                                                                                                                                                                      a schedule listing the names of, and                                                                                                                                                                                                          If you have comments concerning the
the eligible local education agency. List                                                                                                                                                                                                                                       amount of bonds for, each such local                                                                                                                                                                                                          accuracy of these time estimates or
the value of the dollar amount of each                                                                                                                                                                                                                                          education agency.                                                                                                                                                                                                                             suggestions for making this form simpler,
private contribution on the corresponding                                                                                                                                                                                                                                       Line 2.                   If the issuer issued the bonds                                                                                                                                                                                      we would be happy to hear from you. You
line.                                                                                                                                                                                                                                                                           based on a volume cap allocation                                                                                                                                                                                                              can write to the Internal Revenue Service,
Line 5.               For items not listed in lines 1                                                                                                                                                                                                                           received by another authorized entity                                                                                                                                                                                                         Tax Products Coordinating Committee,
through 4, enter the value of the amount                                                                                                                                                                                                                                        (that allocated volume cap to the issue),                                                                                                                                                                                                     SE:W:CAR:MP:T:T:SP, 1111 Constitution
contributed on line 5 and provide a                                                                                                                                                                                                                                             provide the name of such authorized                                                                                                                                                                                                           Ave. NW, IR-6526, Washington, DC
description of such contribution.                                                                                                                                                                                                                                               entity. If more than one authorized entity                                                                                                                                                                                                    20224. Do not send the form to this
                                                                                                                                                                                                                                                                                allocated volume cap to the bond issue,                                                                                                                                                                                                       address. Instead, see Where To File on
Part III—Private Business                                                                                                                                                                                                                                                       attach a schedule listing the names of,                                                                                                                                                                                                       page 1.
Contributor                                                                                                                                                                                                                                                                     and amount of bonds for, each such
                                                                                                                                                                                                                                                                                authorized entity.
Lines 1 through 5.                                                                                         Enter the name and
EIN of the donor of the private business

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