Free Form 8038-CCP (April 2009) - Federal

Form

8038-CP

(April 2009)
Department of the Treasury Internal Revenue Service

Return for Credit Payments to Issuers of Qualified Bonds
2

OMB No. 1545-2142

Part I
1

Information on Entity That Is To Receive Payment of Credit

Check box if Amended Return
Employer identification number (EIN) Room/suite

Name of entity that is to receive payment of the credit

3

Number and street (or P.O. box no. if mail is not delivered to street address)

4

City, town, or post office, state, and ZIP code

5

Name and title of officer or legal representative whom the IRS may call for more information

6

Telephone number of officer or legal representative

(

)

Part II
7

Reporting Authority
8 EIN

Issuer's name (if same as line 1, enter "SAME" and skip lines 8, 9, 11, 15, and 16)

9

Number and street (or P.O. box no. if mail is not delivered to street address)

Room/suite

10

Report number (For IRS Use Only)

8
11 City, town, or post office, state, and ZIP code 12 Date of issue

13

Name of issue

14 CUSIP number

15

Name and title of officer or legal representative whom the IRS may call for more information

16 Telephone number of officer or legal representative

(
17a 18 19 20 a Type of issue Issue price

)
17b

Part III

Payment of Credit

Interest payment date to which this payment of credit relates (MMDDYYYY) Interest payable to bondholders on the interest payment date Amount of credit payment to be received as of the interest payment date (complete line 20a OR line 20b only): Build America bonds. Multiply line 19 by 35% (0.35) b Recovery zone economic development bonds. Multiply line 19 by 45% (0.45) 20a 20b 19

21 a

Adjustment to previous credit payments (complete line 21a OR line 21b only): Net increase to previous payments (attach explanation) b Net decrease to previous payments (attach explanation) 21a 21b ( 22 Yes No
)

22 23 24

Amount of credit payment to be received. Combine line 20a or line 20b with line 21a or line 21b Is this the final interest payment date?

If the entity identified in Part I is not the issuer, check this box to indicate that the entity is authorized to receive payment and related return information on behalf of the issuer
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.

Sign Here
Signature of issuer's authorized representative Date Date Type or print name and title Check if self-employed EIN Phone no. Cat. No. 52810E ( ) Form Preparer's SSN or PTIN

Paid Preparer's Use Only

Preparer's signature Firm's name (or yours if self-employed), address, and ZIP code

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.

8038-CP

(4-2009)