Form 8038-Tc - Information Return For Tax Credit Bonds Page 3

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3
Form 8038-TC (Rev. 11-2012)
Page
Issuer's name:
Issuer's employer identification number (EIN):
Tax Credit Bond Code
Schedule for New Clean Renewable Energy Bonds (New CREBs)
Schedule A
Under Internal Revenue Code sections 54A and 54C
▶
102
See separate instructions
▶
Part I
Issuer Questions
Yes
No
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Is the issuer a public power provider?
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Is the issuer a cooperative electric company? .
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Is the issuer a governmental body?
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Is the issuer a clean renewable energy bond lender? .
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Is the issuer a not-for-profit electric utility which has received a loan/loan guarantee under the Rural
Electrification Act? .
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Have proceeds been used to acquire existing facilities? (see instructions) .
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Have proceeds been used to refinance existing facilities? (see instructions) .
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Is the issue date of the issue on or before the date that is 3 years after the volume cap allocation
date? (see instructions)
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Has the issuer designated these bonds as new CREBs for purposes of section 54C? .
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Part II
Amount
1
(For IRS Use Only) .
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Part III
List of Qualified Renewable Energy Facilities
List the type of qualified renewable energy facilities (see instructions) to be financed by the bonds, the location, the owner of such
facility, the owner's EIN, and the amount of available project proceeds to be used for that facility. (If more than one, attach statement)
Type of Facility:
Location of Facility:
Owner's Name:
Owner's EIN:
Amount of Available Project Proceeds $:
Tax Credit Bond Code
Schedule for Qualified Energy Conservation Bonds (QECBs)
Schedule B
Under Internal Revenue Code sections 54A and 54D
▶
103
See separate instructions
▶
Part I
Issuer and Project Questions
Yes
No
1
1
Has the issuer designated these bonds as QECBs for purposes of section 54D?
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Has the allocation been reallocated from a large local government to a State? .
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Is the issuer a large local government? .
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Is the issuer an Indian tribal government?
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Are all proceeds to be used within the jurisdiction of the issuer? .
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If the issuer issued the bonds based on a volume cap allocation received by another authorized
entity that allocated volume cap to the issue, check “Yes.” If not, check “No.” Provide the name of
such authorized entity. Attach statement if more than one entity's volume cap is used. (see
instructions)
6
Part II
Amount
1
(For IRS Use Only) .
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List of Conservation Purposes, Location of the Facilities, Amount of Proceeds Used for the Purpose,
Part III
Private Activity User, and Private User's EIN
List the type of qualified conservation purpose described under section 54D(f) financed with the proceeds of the bonds, the
1
location of the facility financed with the proceeds of the bond, and the amount of available project proceeds to be used for the
qualified conservation purpose. If the bonds are private activity bonds, provide the name and EIN of all private users. (If the
issuer is issuing bonds for more than one purpose or facility, attach statement)
Type of qualified conservation purpose:
Location of facility financed with bond proceeds:
Amount of proceeds to be used for this purpose $:
Are the bonds private activity bonds?
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Yes
No
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If “Yes,” provide the name and EIN of each private user
8038-TC
Form
(Rev. 11-2012)

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