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Farm 8038-GIC Information Return for Small Tax -Exempt Governmental Bond Issues, Leases, and Installment Sales (Rev. January [he T 1■ under Internal Revenue Code section 149(e) OMB No. 1545 0720 Department of the Treasury Internal Revenue Service Caution: ff the issue price of the issue is $100, 000 or more; use Form 8038-G. lorting Authority Check box it Amended Return I THE ICiT"P 47F SC�'Tff 13FNb IWk3111r�V. ........ �� .. lssirar"s e arptaaywr i¢krnl6l capon rrorertak:r Ih1y it 3 Number and street ('or P.O. trox al malC is notdefivered to street address) Raomrsuile 227 WEST J EFFERSON EBLVD, 4 City,. _..... _ _ -town, po or sl office, stale. and 21P code 5 Report number (For IRS Use Only) or o0un employes of issuer or designated coMict person whom the IRS may call for more inlormation 17 Telephone number of officer or legal Description of 0bll atioins C he'Ck one: a single issue El or a consolidated return I� , 8a Issue price of obligation(s) (see instructions) . . . . . . . . . . . . . . . . 88 b Issue date (single issue) or calendar date (consolidated). Enter date in mm/dd/yyyy format (for example, 01/01/2009) (see instructions) ► 9 Amount of the reported obligations) on line 8a that is; a For leases for vehicles . . . . . . . . . . . . . . . . . . . . 92 b For leases for office equipment - . . . . . . . . . . . . . . . . . . . . 9b c For leases for real property . . . . . . . . . . . . . . . . . . . . . . 9c d For leases for other (see instructions) . . . . . . . . . . . , . . _ _ _ _ 9d e For bank loans for vehicles . . . . . . . . . . . . . . . . . . . . . . . . 9e f For bank loans for office equipment . . . . . . . . . . . . . . . . . . 91! g For bank loans for real property . . . . . . . . . . . . . . . . . . . . . . . 9i h For bank loans for other (see instructions) . . . . . . . . . . . . . . . . . 9h i Used to refund prior issue(s) . . . . . . . . . . . . . . . . , . . . .. 9i i Representing a loan from the proceeds of another tax-exempt obligation (for example, bond bank) 9- k Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9k 10 If the issuer has designated any issue under section 265(b)(3)(13)(i)(III) (small issuer exception), check ............ this box . . - . ► 11 If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check this box (see instructions) . ► I_e) 12 Vendor's or bank's name: ^ 13 Vnnr1nr'9 nr hqintr"c nrnnInvrssr erfnnt fre^afennruimhrrr° under penalties of per)ury, I decare that i have examined trvs return and accompany!n schedules and statements, and to the feast of'ruy kmvhealga and belief„ ffley are Sinature Itue, correct, and complete I hpnher declare that I ooaeaRM to the IRS's d'is,01"rro of t issuer's return information, as necessary to process tCvfg roturn, to theperacrt(� g that I have authorized above. and _ p 74 _._ Consent Signature of issuer's authorized representative Date Type or print name and bile Paid Print/T"ype preparer's name Preparers signature rJate Check ❑ if JiPTIN Prepare' self-employed Use Only rir "s name ► Flint's EIN ■ Frr, ' at�ttlna� q ► Phone na. General Instructions Section references are to the Internal Revenue Code unless otherwise noted. What's New The IRS has created a page an IRS.gov for information about the Form 8038 series and its instructions, at www.irs.gov/formBO38. Information about any future developments affecting the Form 8038 series (such as legislation enacted after we release it) will be posted on that page_ Purpose of Form Form 8038-GC is used by the issuers of tax- exempt governmental obligations to provide the IRS with the information required by section 149(e) and to monitor the requirements of sections 141 through 150, Who Must File Issuers of tax-exempt governmental obligations with issue prices of less than $100,000 must Tile Form 8038-GC. Issuers of a tax-exempt governmental obligation with an issue price of $100.000 or more must file Form 8038-G, Information Return for Tax -Exempt Governmental Obligations. Filing a separate return for a single issue. Issuers have the option to file a separate Form 8038-GC for any tax-exempt governmental obligation with an issue price of less than $100,000. An issuer of a tax-exempt bond used to finance construction expenditures must file a separate Form 8038-GC for each issue to give notice to the IRS that an election was made to pay a penalty in lieu of arbitrage rebate (see the line 11 instructions). Filing a consolidated return for multiple issues. For all tax-exempt governmental obligations with Issue prices of less than $100,000 that are not reported on a separate Form 8038-GC, an issuer must file a consolidated information return including all such issues issued within the calendar year. Thus, an issuer may file a separate Form 8038-GC for each of a number of small issues and report the remainder of small issues issued during the calendar year on one consolidated Form 8038-GC. However, if the issue is a construction issue, a separate Form 8038-GC must be filed to give the IRS notice of the election to pay a penalty in lieu of arbitrage rebate. Cat. No. 64108B Form 80W-GC (Rev, 1 2012)