8038-B
Information Return for Build America Bonds and Recovery
Form
Zone Economic Development Bonds
OMB No. 1545-2161
(Rev. November 2012)
Under Internal Revenue Code section 149(e)
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Department of the Treasury
See separate instructions.
Internal Revenue Service
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Part I
Reporting Authority
Check if Amended Return
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1 Issuer’s name
2 Issuer’s employer identification number (EIN)
DRAFT AS OF
DRAFT AS OF
4 Report number (For IRS Use Only)
3 Name of person (other than issuer) with whom the IRS may communicate about this return (see instructions)
5 Number and street (or P.O. Box if mail is not delivered to street address)
6 City, town, or post office, state, and ZIP code
7 Date of issue (MM/DD/YYYY)
August 8, 2012
July 19, 2012
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8 Name of issue
9 CUSIP number
10 Name and title of officer of issuer whom the IRS may call for more information (see instructions)
11 Telephone number of officer or other person (see instructions)
Part II
Type of Bonds (see instructions, if the box on line 1b or 1c is checked, complete lines 2 and 3)
1 a Build America bonds (Tax Credit) (section 54AA(a)) .
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DO NOT FILE
DO NOT FILE
b Build America bonds (Direct Payment) (sections 54AA(g) and 6431) .
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c Recovery zone economic development bonds (Direct Payment) (sections 1400U-2 and 6431) .
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2
Enter the first interest payment date (MM/DD/YYYY)
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3
Interest payment date frequency: (Check box) (see instructions and attach debt service statement)
a
annual,
b
semi-annual,
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quarterly,
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monthly, or
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other
f If line 3e above is checked, please describe the payment frequency:
Part III
Purpose of Issue
For a build America bond, identify the purpose of issue and enter the issue price. (see instructions
1
Amount
(Whole Dollars)
and attach statement)
a Education .
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1a
b Health and hospital
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1b
c Transportation .
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d Public safety .
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e Environment (including sewage bonds) .
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1e
f Housing
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1f
1g
g Utilities .
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h Other description
1h
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For a recovery zone economic development bond, identify the purpose of issue and enter the issue
2
price. (see instructions and attach statement)
a Capital expenditures relating to property located in the zone .
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2a
b Public infrastructure and construction of public facilities
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2b
c Job training and educational programs .
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d Other description .
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2d
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Total issue price (Part III, lines 1a through 1h or lines 2a through 2d)
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3
4
If obligations are TANs or RANs, check only box 4a
If obligations are BANs, check only box 4b
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5
If obligations are in the form of a lease or installment sale, check box
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Part IV
Description of Obligations (Complete for the entire issue for which this form is being filed.)
1
Stated redemption price at maturity .
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Final maturity date (MM/DD/YYYY)
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3
Weighted average maturity .
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years
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Yield
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%
5
If the issue is a variable rate issue, check box 5a
Please indicate the frequency rates are reset 5b
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8038-B
For Paperwork Reduction Act Notice, see the separate instructions.
Form
(Rev. 11-2012)
Cat. No. 53393K