Information Return for Tax-Exempt Governmental Bonds
Form 8038-G                                            ▶ Under Internal Revenue Code section 149(e) 
(Rev. October 2021)                                          ▶ See separate instructions.                                                  OMB No. 1545-0047
Department of the Treasury             Caution: If the issue price is under $100,000, use Form 8038-GC. 
Internal Revenue Service           ▶ Go to www.irs.gov/F8038G 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 (EIN)

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)
                                                                                                                                                        3 
6    City, town, or post office, state, and ZIP code                                                               7    Date of issue

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.) See the instructions and attach schedule.
11   Education .         . . .   . . . .             . . . . . . .              .   . . . . .        . .  .  .   .   . . .    .       11 
12   Health and hospital         . . . .             . . . . . . .              .   . . . . .        . .  .  .   .   . . .    .       12 
13   Transportation  .       .   . . . .             . . . . . . .              .   . . . . .        . .  .  .   .   . . .    .       13 
14   Public safety .       . .   . . . .             . . . . . . .              .   . . . . .        . .  .  .   .   . . .    .       14 
15   Environment (including sewage bonds)  .               . . . .              .   . . . . .        . .  .  .   .   . . .    .       15 
16   Housing  .          . . .   . . . .             . . . . . . .              .   . . . . .        . .  .  .   .   . . .    .       16 
17   Utilities      .    . . .   . . . .             . . . . . . .              .   . . . . .        . .  .  .   .   . . .    .       17 
18   Other. Describe ▶                                                                                                                18 
19 a If bonds are TANs or RANs, check only box 19a   .           .              .   . . . . .        . .  .  .   .   . .  ▶
 b   If bonds are BANs, check only box 19b  .              . . . .              .   . . . . .        . .  .  .   .   . .  ▶
20   If bonds are in the form of a lease or installment sale, check box                   . .        . .  .  .   .   . .  ▶
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 Bond Issue (including underwriters’ discount)
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 V .                      .        .    27 
28   Proceeds used to refund prior taxable bonds. Complete Part V  .                      . .        .    28 
29   Total (add lines 24 through 28)  .              . . . . . . .              .   . . . . .        . .  .  .   .   . . .    .       29 
30   Nonrefunding proceeds of the issue (subtract line 29 from line 23 and enter amount here)  .                         .    .       30 
Part V   Description of Refunded Bonds. Complete this part only for refunding bonds.
31   Enter the remaining weighted average maturity of the tax-exempt bonds to be refunded  .                           . .  ▶                                years
32   Enter the remaining weighted average maturity of the taxable bonds to be refunded  .                            . . .  ▶                                years
33   Enter the last date on which the refunded tax-exempt bonds will be called (MM/DD/YYYY)  .                           .  ▶
34   Enter the date(s) the refunded bonds were issued  ▶(MM/DD/YYYY)
For Paperwork Reduction Act Notice, see separate instructions.                              Cat. No. 63773S                           Form 8038-G (Rev. 10-2021)

Form 8038-G (Rev. 10-2021)                                                                                                             Page 2 
Part VI  Miscellaneous
35    Enter the amount of the state volume cap allocated to the issue under section 141(b)(5)  .       . . .       35 
 36 a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract  
      (GIC). See instructions     . .  . .   . . .   .          . . .       .  . . .  . . . .  .   . . . . .       36a
b     Enter the final maturity date of the GIC ▶ (MM/DD/YYYY)
c     Enter the name of the GIC provider ▶
37    Pooled financings:  Enter the amount of the proceeds of this issue that are to be used to make loans
      to other governmental units  .   . .   . . .   .          . . .       .  . . .  . . . .  .   . . . . .       37 
38 a  If this issue is a loan made from the proceeds of another tax-exempt issue, check box ▶          and enter the following information: 
b     Enter the date of the master pool bond ▶ (MM/DD/YYYY)
c     Enter the EIN of the issuer of the master pool bond ▶
d     Enter the name of the issuer of the master pool bond ▶
39    If the issuer has designated the issue under section 265(b)(3)(B)(i)(III) (small issuer exception), check box  .         . . .  ▶
40    If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check box  .     .   . . . . .    .  .         . . . .  ▶
41 a  If the issuer has identified a hedge, check here ▶          and enter the following information:
b     Name of hedge provider ▶
c     Type of hedge ▶
d     Term of hedge ▶
42    If the issuer has superintegrated the hedge, check box  .             .  . . .  . . . .  .   . . . . .    .  .         . . . .  ▶
43    If  the  issuer  has  established  written  procedures  to  ensure  that  all  nonqualified  bonds  of  this  issue  are  remediated 
      according to the requirements under the Code and Regulations (see instructions), check box .         .    .  .         . . . .  ▶
44    If the issuer has established written procedures to monitor the requirements of section 148, check box  .              . . . .  ▶
45a   If some portion of the proceeds was used to reimburse expenditures, check here ▶               and enter the amount
      of reimbursement  .     .   . .  . .   . . .   .          . . .       .  ▶
b     Enter the date the official intent was adopted ▶(MM/DD/YYYY) 
            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 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 
Signature   process this return, to the person that I have authorized above.
and         ▲                                                                                 ▲
Consent
                Signature of issuer’s authorized representative                  Date            Type or print name and title
            Print/Type preparer’s name           Preparer’s signature                          Date
Paid                                                                                                       Check         if    PTIN
                                                                                                           self-employed
Preparer                    ▶                                                                          Firm’s EIN ▶
            Firm’s name     
Use Only    Firm’s address ▶                                                                           Phone no.
                                                                                                                   Form 8038-G (Rev. 10-2021)