(Rev. January 2012)
Department of the Treasury
Internal Revenue Service
Information Return for Small Tax-Exempt
Governmental Bond Issues, Leases, and Installment Sales
Under Internal Revenue Code section 149(e)
Caution: If the issue price of the issue is $100,000 or more, use Form 8038-G.
OMB No. 1545-0720
Part I Reporting Authority
Check box if Amended Return
1 Issuer’s name 2
Issuer’s employer identification number (EIN)
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
Telephone number of officer or legal representative
Part II Description of Obligations
Check one: a single issue
or a consolidated return .
8aIssue price of obligation(s) (see instructions) ..................8a
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 obligation(s) on line 8a that is:
a For leases for vehicles .........................
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 .....................9f
g For bank loans for real property.......................9g
h For bank loans for other (see instructions) ...................9h
i Used to refund prior issue(s) .......................9i
Representing a loan from the proceeds of another tax-exempt obligation (for example, bond bank) ..
k Other ...............................9k
10 If the issuer has designated any issue under section 265(b)(3)(B)(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) .......
12 Vendor’s or bank’s name:
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
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.
Signature of issuer’s authorized representative
Type or print name and title
Print/Type preparer’s namePreparer's signatureDate
Section references are to the Internal Revenue
Code unless otherwise noted.
The IRS has created a page on IRS.gov for
information about the Form 8038 series and
its instructions, at www.irs.gov/form8038.
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 file 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
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
Cat. No. 64108B
Form 8038-GC (Rev. 1-2012)
Form 8038-GC (Rev. 1-2012)
When To File
To file a separate return for a single issue, file
Form 8038-GC on or before the 15th day of
the second calendar month after the close of
the calendar quarter in which the issue is
To file a consolidated return for multiple
issues, file Form 8038-GC on or before
February 15th of the calendar year following
the year in which the issue is issued.
Late filing. An issuer may be granted an
extension of time to file Form 8038-GC under
section 3 of Rev. Proc. 2002-48, 2002-37
I.R.B. 531, if it is determined that the failure to
file on time is not due to willful neglect. Type
or print at the top of the form, “Request for
Relief under section 3 of Rev. Proc. 2002-48.”
Attach to the Form 8038-GC a letter briefly
stating why the form was not submitted to the
IRS on time. Also indicate whether the
obligation in question is under examination by
the IRS. Do not submit copies of any bond
documents, leases, or installment sale
documents. See Where To File next.
Where To File
File Form 8038-GC, and any attachments,
with the Department of the Treasury, Internal
Revenue Service Center, Ogden, UT 84201.
Private delivery services. You can use
certain private delivery services designated by
the IRS to meet the “timely mailing as timely
filing/paying” rule for tax returns and
payments. These private delivery services
include only the following:
• DHL Express (DHL): DHL Same Day Service.
• Federal Express (FedEx): FedEx Priority
Overnight, FedEx Standard Overnight, FedEx
2Day, FedEx International Priority, and FedEx
• United Parcel Service (UPS): UPS Next Day
Air, UPS Next Day Air Saver, UPS 2nd Day
Air, UPS 2nd Day Air A.M., UPS Worldwide
Express Plus, and UPS Worldwide Express.
The private delivery service can tell you
how to get written proof of the mailing date.
Other Forms That May Be
For rebating arbitrage (or paying a penalty in
lieu of arbitrage rebate) to the Federal
Government, use Form 8038-T, Arbitrage
Rebate, Yield Reduction and Penalty in Lieu
of Arbitrage Rebate. For private activity
bonds, use Form 8038, Information Return for
Tax-Exempt Private Activity Bond Issues.
For a tax-exempt governmental obligation
with an issue price of $100,000 or more, use
Rounding to Whole Dollars
You may show the money items on this return
as whole-dollar amounts. To do so, drop any
amount less than 50 cents and increase any
amount from 50 to 99 cents to the next higher
Obligations. This refers to a single tax-
exempt governmental obligation if Form
8038-GC is used for separate reporting or to
multiple tax-exempt governmental obligations
if the form is used for consolidated reporting.
Tax-exempt obligation. This is any obligation
including a bond, installment purchase
agreement, or financial lease, on which the
interest is excluded from income under
Tax-exempt governmental obligation. A
tax-exempt obligation that is not a private
activity bond (see below) is a tax-exempt
governmental obligation. This includes a bond
issued by a qualified volunteer fire department
under section 150(e).
Private activity bond. This includes an
obligationissued as part of an issue in which:
• More than 10% of the proceeds are to be
used for any private activity business use, and
• More than 10% of the payment of principal
or interest of the issue is either (a) secured by
an interest in property to be used for a private
business use (or payments for such property)
or (b) to be derived from payments for
property (or borrowed money) used for a
private business use.
It also includes a bond, the proceeds of
which (a) are to be used to make or finance
loans (other than loans described in section
141(c)(2)) to persons other than governmental
units and (b) exceeds the lesser of 5% of the
proceeds or $5 million.
Issue. Generally, obligations are treated as
part of the same issue only if they are issued
by the same issuer, on the same date, and as
part of a singletransaction, or a series of
related transactions. However, obligations
issued during the same calendar year (a)
under a loan agreement under which amounts
are to be advanced periodically (a “draw-
down loan”) or (b) with a term not exceeding
270 days, may be treated as part of the same
issue if the obligations are equally and ratably
secured under a single indenture or loan
agreement and are issued under a common
financing arrangement (for example, under the
same official statement periodically updated
to reflect changing factual circumstances).
Also, for obligations issued under a draw-
down loan that meets the requirements of the
preceding sentence, obligations issued during
different calendar years may be treated as
part of the same issue if all of the amounts to
be advanced under the draw-down loan are
reasonably expected to be advanced within 3
years of the date of issue of the first
obligation. Likewise, obligations (other than
private activity bonds) issued under a single
agreement that is in the form of a lease or
installment sale may be treated as part of the
same issue if all of the property covered by
that agreement is reasonably expected to be
delivered within 3 years of the date of issue of
the first obligation.
Arbitrage rebate. Generally, interest on a
state or local bond is not tax-exempt unless
the issuer of thebond rebates to the United
States arbitrage profits earned from investing
proceeds of the bond in higher yielding
nonpurpose investments. See section 148(f).
Construction issue. This is an issue of tax-
exempt bonds that meets both of the
1. At least 75% of the available construction
proceeds of the issue are to be used for
construction expenditures with respect to
property to be owned by a governmental unit
or a 501(c)(3) organization, and
2. All of the bonds that are part of the issue
arequalified 501(c)(3) bonds, bonds that are
not privateactivity bonds, or private activity
bonds issued tofinance property to be owned
by a governmental unitor a 501(c)(3)
In lieu of rebating any arbitrage that may be
owed to the United States, the issuer of a
construction issue may make an irrevocable
election to pay a penalty. The penalty is equal
to 1-1/2% of the amount of construction
proceeds that do not meet certain spending
requirements. See section 148(f)(4)(C) and the
Instructions for Form 8038-T.
In general, a Form 8038-GC must be
completed on the basis of available
information and reasonable expectations as of
the date of issue. However, forms that are
filed on a consolidated basis may be
completed on the basis of information readily
available to the issuer at the close of the
calendar year to which the form relates,
supplemented by estimates made in good
Part I—Reporting Authority
Amended return. An issuer may file an
amended return to change or add to the
information reported on a previously filed
return for the same date ofissue. If you are
filing to correct errors or change apreviously
filed return, check the “Amended Return” box
in the heading of the form.
The amended return must provide all the
information reported on the original return, in
addition to the new corrected information.
Attach an explanation of the reason for the
amended return and write across the top
"Amended Return Explanation."
Line 1. The issuer’s name is the name of the
entity issuing the obligations, not the name of
the entity receiving the benefit of the
financing. In the case of a lease or installment
sale, the issuer is the lessee or purchaser.
Line 2. An issuer that does not have an
employer identification number (EIN) should
apply for one on Form SS-4, Application for
Employer Identification Number. You can get
this form on the IRS website atIRS.govor by
calling 1-800-TAX-FORM (1-800-829-3676).
You may receive an EIN bytelephone by
following the instructions for Form SS-4.
Lines 3 and 4. Enter the issuer’s address or
the address of the designated contact person
listed on line 6. If the issuer wishes to use its
own address and theissuer receives its mail
in care of a third partyauthorized
representative (such as an accountant or
attorney), enter on the street address line
“C/O”followed by the third party's name and
streetaddress or P.O. box. Include the suite,
room, or otherunit number after the street
address. If the post office does not deliver
mail to the street address and the issuer has a
P.O. box, show the box number instead of the
Form 8038-GC (Rev. 1-2012)
street address. If a change in address occurs
after the return is filed, use Form 8822,
Change of Address, to notify the IRS of the
Note. The address entered on lines 3 and 4 is
the address the IRS will use for all written
communications regarding the processing of
this return, including any notices. By
authorizing a person other than an authorized
officer or other employee of the issuer to
communicate with the IRS and whom the IRS
may contact about this return, the issuer
authorizes the IRS to communicate directly
with the individual listed on line 6, whose
address is entered on lines 3 and 4 and
consents to disclose the issuer's return
information to that individual, as necessary, to
process this return.
Line 5. This line is for IRS use only. Do not
makeany entries in this box.
Part II—Description of Obligations
Check the appropriate box designating this as
a return on a single issue basis or a
consolidated return basis.
Line 8a. The issue price of obligations is
generallydetermined under Regulations
section 1.148-1(b). Thus, when issued for
cash, the issue price is the price at which a
substantial amount of the obligations are sold
to the public. To determine the issue price of
an obligation issued for property, see sections
1273 and 1274 and the related regulations.
Line 8b. For a single issue, enter the date of
issue (for example, 03/15/2010 for a single
issue issued on March 15, 2010), generally
the date on which theissuer physically
exchanges the bonds that are partof the
issue for the underwriter’s (or other
purchaser’s) funds; for a lease or installment
sale,enter the date interest starts to accrue.
For issues reported on a consolidated basis,
enter the first day of the calendar year during
which the obligations were issued (for
example, for calendar year 2010, enter
Lines 9a through 9h. Complete this section if
property other than cash is exchanged for the
obligation, for example, acquiring a police car,
a fire truck, or telephone equipment through a
series of monthly payments. (This type of
obligation is sometimes referred to as a
“municipal lease.”) Also complete this section
if real property is directly acquired in
exchangefor an obligation to make periodic
payments of interest and principal.
Do not complete lines 9a through 9d if the
proceeds of an obligation are received in the
form of cash even if the term “lease” is used
in the title of the issue. For lines 9a through
9d, enter the amount on the appropriate line
that represents a lease or installment
purchase. For line 9d, enter the type ofitem
that is leased. For lines 9e through 9h, enter
the amount on the appropriate line that
represents a bank loan. For line 9h, enter the
type of bank loan.
Lines 9i and 9j. For line 9i, enter the amount
of the proceeds that will be used to pay
principal, interest, or call premium on any
other issue of bonds,including proceeds that
will be used to fund an escrow account for
this purpose. Several lines may apply to a
particular obligation. For example, report on
lines 9i and 9j obligations used to refund prior
issues which represent loans from the
proceeds of another tax-exempt obligation.
Line 9k. Enter on line 9k the amount on line
8a that does not represent an obligation
described on lines 9a through 9j.
Line 10. Check this box if the issuer has
designated any issue as a “small issuer
exception” under section 265(b)(3)(B)(i)(III).
Line 11. Check this box if the issue is a
construction issue and an irrevocable election
to pay a penalty in lieu of arbitrage rebate has
been made on or before the date the bonds
were issued. The penalty is payable with a
Form 8038-T for each 6-month period after
the date the bonds are issued. Do not make
any payment of penalty in lieu of rebate with
Form 8038-GC. See Rev. Proc. 92-22,
1992-1 C.B. 736, for rules regarding the
Line 12. Enter the name of the vendor or bank
who is a party to the installment purchase
agreement, loan, or financial lease. If there
are multiple vendors or banks, the issuer
should attach a schedule.
Line 13. Enter the employer identification
number ofthe vendor or bank who is a party
to the installment purchase agreement, loan,
or financial lease. If there are multiple vendors
or banks, the issuer should attach a schedule.
Signature and Consent
An authorized representative of the issuer
must sign Form 8038-GC and any applicable
certification. Also print the name and title of
the person signing Form 8038-GC. The
authorized representative of the issuer signing
this form must have the authority to consent
to the disclosure of the issuer's return
information, as necessary to process this
return, to the person(s) that has been
designated in this form.
Note. If the issuer authorizes in line 6 the IRS
to communicate with a person other than an
officer or other employee of the issuer, (such
authorization shall include contact both in
writing regardless of the address entered in
lines 3 and 4, and by telephone) by signing
this form, the issuer's authorized
representative consents to the disclosure of
the issuer's return information, as necessary
to process this return, to such person.
If an authorized representative of the issuer
filled in its return, the paid preparer’s space
should remain blank. Anyone who prepares
the return but does not charge the
organization should not sign the return.
Certain others who prepare the return should
not sign. For example, a regular, full-time
employee of the issuer, such as a clerk,
secretary, etc., should not sign.
Generally, anyone who is paid to prepare a
return must sign it and fill in the other blanks
in the Paid Preparer Use Only area of the
return. A paid preparer cannot use a social
security number in the Paid Preparer Use Only
box. The paid preparer must use a preparer
tax identification number (PTIN). If the paid
preparer is self-employed, the preparer
should enter his or her address in the box.
The paid preparer must:
• Sign the return in the space provided for the
preparer’s signature, and
• Give a copy of the return to the issuer.
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administration of any Internal Revenue law.
Generally, tax returns and return information
are confidential, as required by section 6103.
The time needed to complete and file this
form will vary depending on individual
circumstances. The estimated average time is:
Learning about the
law or the form ....4 hr., 46 min.
Preparing the form ....2 hr., 22 min.
Copying, assembling, and
sending the form to the IRS .2 hr., 34 min.
If you have comments concerning the
accuracy of these time estimates or
suggestions for making this form simpler, we
would be happy to hear from you. You can
write to the Internal Revenue Service, Tax
Products Coordinating Committee,
SE:W:CAR:MP:T:M:S, 1111 Constitution Ave.
NW, IR-6526, Washington, DC 20224. Do not
send the form to this address. Instead, see
Where To File.