Information Return for Tax-Exempt Private Activity Bond Issues
Form   8038                                          (Under Internal Revenue Code section 149(e))                                        OMB No. 1545-0047
(Rev. October 2021)
Department of the Treasury                               ▶ See separate instructions.  
Internal Revenue Service        ▶ Go to www.irs.gov/Form8038 for instructions and the latest information.
Part I  Reporting Authority                                                                                            Check box if Amended Return   ▶
1    Issuer’s name                                                                                                2    Issuer’s employer identification number 

3a    Name of person (other than issuer) with whom the IRS may communicate about this return (see instructions)   3b  Telephone number of other person shown on 3a

4    Number and street (or P.O. box if mail is not delivered to street address)           Room/suite              5   Report number (For IRS Use Only)
                                                                                                                       1
6    City, town, or post office, state, and ZIP code                                                              7    Date of issue (MM/DD/YYYY)

8    Name of issue                                                                                                9    CUSIP number

10a  Name and title of officer or other employee of the issuer whom the IRS may call for more information         10b  Telephone number of officer or other employee shown on 10a

Part II Type of Issue (Enter the issue price.)                                                                                                   Issue Price
11     Exempt facility bond:
a      Airport (sections 142(a)(1) and 142(c)) .     . . . .  .                 . . . . . . . .           .     . .    . . . .       11a
b      Docks and wharves (sections 142(a)(2) and 142(c))  .                     . . . . . . . .           .     . .    . . . .       11b
c      Water furnishing facilities (sections 142(a)(4) and 142(e))                . . . . . . .           .     . .    . . . .       11c
d      Sewage facilities (section 142(a)(5))  .      . . . .  .                 . . . . . . . .           .     . .    . . . .       11d
e      Solid waste disposal facilities (section 142(a)(6))  . .                 . . . . . . . .           .     . .    . . . .       11e
f      Qualified residential rental projects (sections 142(a)(7) and 142(d)) (see instructions)  .                     . . . .       11f
       Meeting 20–50 test (section 142(d)(1)(A))       . . .  .                 . . . . . . . .
       Meeting 40–60 test (section 142(d)(1)(B))       . . .  .                 . . . . . . . .
       Meeting 25–60 test (NYC only) (section 142(d)(6)) .    .                 . . . . . . . .
       Has an election been made for deep rent skewing (section 142(d)(4)(B))?  .             .                   Yes        No
g      Facilities for the local furnishing of electric energy or gas (sections 142(a)(8) and 142(f))                   . . . .       11g
h      Facilities allowed under a transitional rule of the Tax Reform Act of 1986 (see instructions)  .                    . .       11h
       Facility type
       1986 Act section
i      Qualified enterprise zone facility bonds (section 1394) (see instructions)  .          .           .     . .    . . . .       11i
j      Qualified empowerment zone facility bonds (section 1394(f)) (see instructions)  .                        . .    . . . .       11j
k      Other (see instructions)                                                                                                      11k
l      Qualified public educational facility bonds (sections 142(a)(13) and 142(k))           .           .     . .    . . . .       11l
m      Mass commuting facilities (sections 142(a)(3) and 142(c))  .                 . . . . . .           .     . .    . . . .       11m
n      Qualified highway or surface freight transfer facilities (sections 142(a)(15) and 142(m)) .                     . . . .       11n
o      Other (see instructions)
p      Local district heating or cooling facilities (sections 142(a)(9) and 142(g))                                                  11p
q      Other (see instructions)                                                                                                      11q
12a    Qualified mortgage bond (section 143(a))        . . .  .                 . . . . . . . .           .     . .    . . . .       12a
b      Other (see instructions)                                                                                                      12b
13     Qualified veterans’ mortgage bond (section 143(b)) (see instructions)  .             . .           .     . .    . . .    ▶    13 
       Check the box if you elect to rebate arbitrage profits to the United States            .           .     . .    .
14     Qualified small issue bond (section 144(a)) (see instructions)  .              . . . . .           .     . .    . . .  ▶      14 
       Check the box for $10 million small issue exemption                      . . . . . . . .           .     . .    .
15     Qualified student loan bond (section 144(b))      . .  .                 . . . . . . . .           .     . .    . . . .       15 
16     Qualified redevelopment bond (section 144(c))       .  .                 . . . . . . . .           .     . .    . . . .       16 
17     Qualified hospital bond (section 145(c)) (attach schedule—see instructions)  .                     .     . .    . . . .       17 
18     Qualified 501(c)(3) nonhospital bond (section 145(b)) (attach schedule—see instructions) .                        . . .       18 
       Check box if 95% or more of net proceeds will be used only for capital expenditures .                            ▶
19     Nongovernmental output property bond (treated as private activity bond) (section 141(d))                          . . .       19 
20a    Other (see instructions)
b      Reissuance (see instructions)                                                                                                 20b
c      Other. Describe (see instructions) ▶                                                                                          20c
For Paperwork Reduction Act Notice, see separate instructions.                            Cat. No. 49973K                            Form 8038 (Rev. 10-2021) 

Form 8038 (Rev. 10-2021)                                                                                                                 Page 2 
Part III Description of Bonds (Complete for the entire issue for which this form is being filed.)
         (a) Final maturity date       (b) Issue price             (c) Stated redemption         (d) Weighted                 (e) Yield
                                                                     price at maturity         average maturity
21                                 $                       $                                                   years                           % 
Part IV  Uses of Proceeds of Issue (including underwriters’ discount)                                                           Amount
22   Proceeds used for accrued interest  .   . .       . . .       .   . . . . .        . . .  . .   . . .     .     22 
23   Issue price of entire issue (enter amount from line 21, column (b))     . .        . . .  . .   . . .     .     23 
24   Proceeds used for bond issuance costs (including underwriters’ discount)               24 
25   Proceeds used for credit enhancement  .   .       . . .       .   . . . . .        .   25 
26   Proceeds allocated to reasonably required reserve or replacement fund  .               26 
27   Proceeds used to refund prior tax-exempt bonds. Complete Part VI          .        .   27 
28   Proceeds used to refund prior taxable bonds. Complete Parts V and VI  .                28 
29   Add lines 24 through 28  .      . . . . . .       . . .       .   . . . . .        . . .  . .   . . .     .     29 
30   Nonrefunding proceeds (subtract line 29 from line 23, enter amount here, and complete Part V)  .                30 
Part V   Description of Property Financed 
         Caution: Do not complete for qualified student loan bonds, qualified mortgage bonds, or qualified veterans’ mortgage 
                         bonds.
31   Type of Property Financed:                                                                                                 Amount
a    Land  . . .         . .     . . . . . . . .       . . .       .   . . . . .        . . .  . .   . . .     .     31a
b    Buildings and structures  .     . . . . . .       . . .       .   . . . . .        . . .  . .   . . .     .     31b
c    Equipment with recovery period of more than 5 years  .            . . . . .        . . .  . .   . . .     .     31c
d    Equipment with recovery period of 5 years or less     .       .   . . . . .        . . .  . .   . . .     .     31d
e    Other. Describe (see instructions)                                                                              31e
32   North American Industry Classification System (NAICS) of the projects financed.
         NAICS Code                Amount of nonrefunding proceeds             NAICS Code              Amount of nonrefunding proceeds
a                                $                                       c                           $
b                           $                                            d                           $
Part VI  Description of Refunded Bonds (Complete this part only for refunding bonds.)
33   Enter the remaining weighted average maturity of the tax-exempt bonds to be refunded .            . .     . .  ▶                    years
34   Enter the remaining weighted average maturity of the taxable bonds to be refunded  .            . . .     . .    ▶                  years
35   Enter the last date on which the refunded tax-exempt bonds will be called (MM/DD/YYYY) .            .     . .  ▶         /     /
36   Enter the date(s) the refunded bonds were issued (MM/DD/YYYY)  .          .        . . .  . .   . . .     . .  ▶         /     /
Part VII Miscellaneous
37   Name of governmental unit(s) approving issue (see the instructions) ▶

38   Check the box if you have designated any issue under section 265(b)(3)(B)(i)(III) .       . .   . . .     . .   .  .   . .   .    .    ▶
39   Check the box if you have elected to pay a penalty in lieu of arbitrage rebate         .  . .   . . .     . .   .  .   . .   .    .  ▶
40 a Check the box if you have identified a hedge and enter the following information          . .   . . .     . .   .  .   . .   .    . ▶ 
b    Name of hedge provider
c    Type of hedge ▶
d    Term of hedge ▶
41   Check the box if the hedge is superintegrated .     . .       .   . . . . .        . . .  . .   . . .     . .   .  .   . .   .    .  ▶
42 a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract (GIC) ▶
b    Enter the final maturity date of the GIC (MM/DD/YYYY) .           . . . . .        . . .  . .   . . .     . .   .  ▶     /     /
c    Enter the name of the GIC provider  ▶
43   Check  the  box  if  the  issuer  has  established  written  procedures  to  ensure  that  all  nonqualified  bonds  of  this  issue  are 
     remediated in accordance with the requirements under the Code and Regulations (see instructions) .              .  .   . .   .    .  ▶
44   Check the box if the issuer has established written procedures to monitor the requirements of section 148              . .   .    .  ▶
45a  Enter the amount of reimbursement if some portion of the proceeds was used to reimburse expenditures .  ▶
b    Enter the date the official intent was adopted (MM/DD/YYYY)           . . .        . . .  . .   . . .     . .   .  ▶     /     /
46   Check the box if the issue is comprised of qualified redevelopment, qualified small issue, or exempt facilities bonds, and 
     provide name and EIN of the primary private user      .       .   . . . . .        . . .  . .   . . .     . .   .  .   . .   .    .    ▶

     Name ▶                                                                                                      EIN
                                                                                                                        Form 8038 (Rev. 10-2021) 

Form 8038 (Rev. 10-2021)                                                                                                        Page 3 
Part VIII Volume Caps                                                                                                     Amount
47   Amount of state volume cap allocated to the issuer. Attach copy of state certification   .     . . .          47
48   Amount of issue subject to the unified state volume cap          .   . . . . .  . . .  . .     . . .          48
49   Amount of issue not subject to the unified state volume cap or other volume limitations:                      49
a    Of bonds for governmentally owned solid waste facilities, airports, docks, wharves, environmental 
     enhancements of hydroelectric generating facilities, or high-speed intercity rail facilities . . . .          49a
b    Under a carryforward election. Attach a copy of Form 8328 to this return  .     . . .  . .     . . .          49b
c    Under transitional rules of the Tax Reform Act of 1986. Enter Act section ▶                                   49c
d    Under the exception for current refunding (section 146(i) and section 1313(a) of the Tax Reform Act of 1986)  49d
50a  Amount of issue of qualified veterans’ mortgage bonds .          .   . . . . .  . . .  . .     . . .          50a
b    Enter the state limit on qualified veterans’ mortgage bonds          . . . . .  . . .  . .     . . .          50b
51a  Amount of section 1394(f) volume cap allocated to issuer. Attach copy of local government certification       51a
b    Name of empowerment zone ▶
52   Amount of section 142(k)(5) volume cap allocated to issuer.          Attach copy of state certification       52
          Under penalties of perjury, I declare that I have examined this return, and accompanying schedules and statements, and to the best of my knowledge and 
Signature belief, they are true, correct, and complete. I further declare that I consent to the IRS’s disclosure of the issuer’s return information, as necessary to process 
and       this▲ return, to the person(s) that I have authorized above.                     ▲
Consent
                Signature of issuer’s authorized representative                 Date          Type or print name and title
          Print/Type preparer’s name                 Preparer’s signature                Date                             Preparer’s PTIN
Paid                                                                                                    Check         if 
                                                                                                        self-employed
Preparer 
Use Only  Firm’s name      ▶                                                                        Firm’s EIN  ▶
          Firm’s address  ▶                                                                         Phone no.
                                                                                                                   Form 8038 (Rev. 10-2021)