Form 14127 - Direct Pay Bonds Compliance Check Questionnaire - 2010
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4Department of the Treasury — Internal Revenue Service
14127
Direct Pay Bonds Compliance Check
Form
OMB No. 1545-2071
(May 2010)
Questionnaire
We are asking for information regarding your Direct Pay Bonds, post-issuance bond compliance and record retention
practices. Direct Pay Bonds referred to in this questionnaire are Build America Bonds described in section 54AA(g) of the
Internal Revenue Code. Please complete the questionnaire and follow the instructions in the accompanying letter for
returning it to us. Please note that section references in this questionnaire are to sections of the Internal Revenue Code
unless otherwise indicated. For all accompanying documentation, please clearly label the question to which it relates.
Name of Governmental Entity:
Employer Identification Number:
Yes
No
1. Have any of your Direct Pay Bonds been initially sold to the underwriter or
initial purchaser of the Direct Pay Bonds pursuant to a negotiated sale (not a
competitive sale)?
Yes
No
If Yes, did the underwriter provide the issuer with a written certification to the
effect that each maturity of each issue of the Direct Pay Bonds was offered
to the public in a bona fide public offering (excluding bond houses, brokers,
or similar persons or organizations acting in the capacity of underwriters or
wholesalers) at the initial offering price for such maturity?
Yes
No
If Yes, were any amounts of an issue of your Direct Pay Bonds purchased in
the initial offering to the public by affiliates or affiliated accounts of the
Underwriter did not disclose
underwriter?
Yes
No
2. Do you have written procedures to ensure that none of the maturities of any
issue of your Direct Pay Bonds are issued with more than a de minimis
amount of premium as required by section 54AA(d)(2)(C)?
If Yes, date they were implemented?
(mm/dd/yyyy)
If Yes, describe in detail your procedures for ensuring compliance with such de minimis rule, including but not limited to
procedures to evaluate related certifications of third parties (e.g., issue price certificates), and how you implement such
procedures, including dates of revisions, if any. In lieu of the above description, you may attach a copy of your written
procedures. If you have no written procedures, explain what guidelines you have in place and from what source these
guidelines are derived that ensure Direct Pay Bonds satisfy the de minimis rule.
(Attach sheet with description)
14127
Catalog Number 54588D
Form
(Rev. 05-2010)
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