Form Ic-085 - Report Of Conduit Revenue Bonds Issued - Wisconsin Department Of Revenue
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REPORT OF CONDUIT REVENUE BONDS ISSUED
Wisconsin Department of Revenue
Name of Commission
Name of Contact Person
Telephone number
Address
State
Zip code
BOND INFORMATION
1. Title of bond
2. Date bond issued
3. CUSIP number of bond
4. Is interest income from this bond exempt from Wisconsin income tax?
Yes
No
5. If interest income is exempt from Wisconsin income tax, check whichever of the following applies:
The bonds or notes are used to fund multifamily affordable housing projects or elderly housing
projects in Wisconsin, and the Wisconsin Housing and Economic Development Authority has
the authority to issue its bonds or notes for the project being funded.
The bonds or notes are used by a health facility, as defined in sec. 231.01(5), Wis. Stats., to
fund the acquisition of information technology hardware or software, in Wisconsin, and the
Wisconsin Health and Educational Facilities Authority has the authority to issue its bonds or
notes for the project being funded.
The bonds or notes are issued to fund a redevelopment project in Wisconsin or a housing
project in Wisconsin, and the authority exists for bonds or notes to be issued by an entity
described under sec. 66.1201, 66.1333, or 66.1335.
Authorized Signature
Date
PURPOSE OF FORM
A commission (entity created by two or more political subdivisions, which contract with each other under
sec. 66.0301(2) or 66.0303(2) for the purpose of issuing conduit revenue bonds under sec. 66.0304, Wis. Stats.)
is required to notify the Department of Revenue when a bond is issued. This form is to be used for the notification.
WHERE TO FILE
Mail the completed form to: Wisconsin Department of Revenue
Admin. – Technical Services Section
Mail Stop 6-40
PO Box 8933
Madison WI 53708-8933
IC-085 (R. 11-12)
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