Form 8038-Gc - Information Return For Small Tax-Exempt Governmental Bond Issues, Leases, And Installment Sales
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38038-GC
Information Return for Small Tax-Exempt
Form
Governmental Bond Issues, Leases, and Installment Sales
(Rev. January 2012)
OMB No. 1545-0720
Under Internal Revenue Code section 149(e)
▶
Department of the Treasury
Caution: If the issue price of the issue is $100,000 or more, use Form 8038-G.
Internal Revenue Service
Part I
Reporting Authority
Check box if Amended Return
▶
1
2 Issuer’s employer identification number (EIN)
Issuer’s name
3
Number and street (or P.O. box if mail is not delivered to street address)
Room/suite
4
City, town, or post office, state, and ZIP code
5 Report number (For IRS Use Only)
6 Name and title of officer or other employee of issuer or designated contact person whom the IRS may call for more information 7 Telephone number of officer or legal representative
Description of Obligations Check one: a single issue
or a consolidated return
.
Part II
8a Issue price of obligation(s) (see instructions)
8a
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b Issue date (single issue) or calendar date (consolidated). Enter date in mm/dd/yyyy format (for
example, 01/01/2009) (see instructions)
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9
Amount of the reported obligation(s) on line 8a that is:
a For leases for vehicles
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9a
b For leases for office equipment .
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9b
c For leases for real property .
9c
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d For leases for other (see instructions) .
9d
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e For bank loans for vehicles .
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9e
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For bank loans for office equipment .
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9f
g For bank loans for real property.
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9g
h For bank loans for other (see instructions) .
9h
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i
9i
Used to refund prior issue(s)
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j
9j
Representing a loan from the proceeds of another tax-exempt obligation (for example, bond bank) .
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k Other .
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9k
10
If the issuer has designated any issue under section 265(b)(3)(B)(i)(III) (small issuer exception), check this box .
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11
If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check this box (see instructions) .
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Vendor’s or bank’s name:
13
Vendor’s or bank’s employer identification number:
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
Signature
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 this return, to the person(s)
that I have authorized above.
and
Consent
Type or print name and title
Signature of issuer’s authorized representative
Date
Print/Type preparer’s name
Preparer's signature
Date
PTIN
Paid
Check
if
self-employed
Preparer
Use Only
Firm’s name
Firm's EIN
▶
▶
Firm's address
Phone no.
▶
General Instructions
Who Must File
pay a penalty in lieu of arbitrage rebate (see
the line 11 instructions).
Issuers of tax-exempt governmental
Section references are to the Internal Revenue
obligations with issue prices of less than
Filing a consolidated return for multiple
Code unless otherwise noted.
$100,000 must file Form 8038-GC.
issues. For all tax-exempt governmental
What's New
obligations with issue prices of less than
Issuers of a tax-exempt governmental
$100,000 that are not reported on a separate
The IRS has created a page on IRS.gov for
obligation with an issue price of $100,000 or
Form 8038-GC, an issuer must file a
information about the Form 8038 series and
more must file Form 8038-G, Information
consolidated information return including all
its instructions, at
Return for Tax-Exempt Governmental
such issues issued within the calendar year.
Information about any future developments
Obligations.
affecting the Form 8038 series (such as
Thus, an issuer may file a separate Form
Filing a separate return for a single issue.
legislation enacted after we release it) will be
8038-GC for each of a number of small issues
Issuers have the option to file a separate
posted on that page.
and report the remainder of small issues
Form 8038-GC for any tax-exempt
issued during the calendar year on one
governmental obligation with an issue price
Purpose of Form
consolidated Form 8038-GC. However, if the
of less than $100,000.
issue is a construction issue, a separate Form
Form 8038-GC is used by the issuers of tax-
An issuer of a tax-exempt bond used to
8038-GC must be filed to give the IRS notice
exempt governmental obligations to provide
finance construction expenditures must file a
of the election to pay a penalty in lieu of
the IRS with the information required by
separate Form 8038-GC for each issue to give
arbitrage rebate.
section 149(e) and to monitor the
notice to the IRS that an election was made to
requirements of sections 141 through 150.
8038-GC
Form
(Rev. 1-2012)
Cat. No. 64108B
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