Return for Credit Payments to Issuers of Qualified Bonds

• Legal Form Number: 8038-CP
• Year: 2022
• Issuer: Treasury Department
• Section: Treasury Department

Form 8038-CP

(Rev. January 2022)

Return for Credit Payments

to Issuers of Qualified Bonds

Department of the Treasury

Internal Revenue Service

▶Go to www.irs.gov/Form8038CP for instructions and the latest information.

OMB No. 1545-0047

Check if Amended Return (see instructions)▶

Part I

Information on Entity That Is To Receive Payment

1 Name of entity that is to receive payment of the credit2 Employer identification number (EIN)

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

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

5 Name and title of designated contact person whom the IRS may contact for more information

6 Telephone number of contact person shown on line 5

Part IIReporting Authority

7 Issuer’s name (if same as line 1, enter “SAME” and skip lines 8, 9, 11, 15, and 16)8 EIN

9 Number and street (or P.O. box no. if mail is not delivered to street address)Room/suite10 Report number (see instructions)

11 City, town, or post office; state; and ZIP code12 Date of issue (MM/DD/YYYY)

13 Name of issue14 CUSIP number (see instructions)

15 Name and title of officer or other person whom the IRS may contact for more information16

Telephone number of contact person shown on line 15

17a

Check applicable box (see instructions)

▶

Variable rate bondFixed rate bond

b

Enter the issue price ▶

17b

cEnter code number for type of bonds (see instructions) ............

Part IIIPayment of Credit (For specified tax credit bonds with multiple maturities, see instructions.)

18Interest payment date to which this payment of credit relates (MM/DD/YYYY)

19aInterest payable to bondholders on the interest payment date. See instructions ..........19a

b

For specified tax credit bonds only, enter the applicable credit rate determined under sec. 54A(b)(3)

.

%

cFor specified tax credit bonds only, complete Schedule A and enter amount from Schedule A, line 3...19c

20

Amount of credit allowed for the interest payment date (complete only line 20a, 20b, 20c, 20d, 20e, or 20f)

aBuild America bonds. Multiply line 19a by 35% (0.35) .................20a

bRecovery zone economic development bonds. Multiply line 19a by 45% (0.45) ..........20b

cNew clean renewable energy bonds, enter the smaller of lines 19a or 19c ...........20c

dQualified energy conservation bonds, enter the smaller of lines 19a or 19c ...........20d

eQualified zone academy bonds, enter the smaller of lines 19a or 19c .............20e

fQualified school construction bonds, enter the smaller of lines 19a or 19c ...........20f

21Adjustment to previous credit payments (complete line 21a OR line 21b only):

aNet increase to previous payments ......................21a

bNet decrease to previous payments ......................21b

cEnter explanation code for lines 21a or 21b (see instructions) ..........

22

Amount of credit payment requested. Combine either line 20a, 20b, 20c, 20d, 20e, or 20f with line 21a or line 21b.

22

23aHas there been a change to the debt service schedule most recently filed with the IRS?..........YesNo

b

If “Yes,” enter the explanation code and attach the revised debt service schedule (see instructions)

24aHave you paid or will you pay all the interest from line 19a on or before the date from line 18? See instructions...YesNo

bIf “No,” enter the explanation code (see instructions).............

25Is this return submitted for the final interest payment date for the bonds? ..............YesNo

Direct

Deposit

26Enter direct deposit information below:

a Routing number▶

b Type:

CheckingSavings

c Account number

Signature

and

Consent

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 authorize the IRS to send the requested refundable credit payment to the entity

identified in Part I, and I consent to the disclosure of the issuer’s return information, as necessary to process the refundable credit payment, to the

designated contact person(s) listed above in Parts I and II, as applicable.

▲

Signature of issuerDate

▶

Type or print name and title

Paid

Preparer

Use Only

Print/Type preparer’s namePreparer’s signatureDateCheck if

self-employed

PTIN

Firm’s name ▶Firm’s EIN ▶

Firm’s address ▶Phone no.

For Paperwork Reduction Act Notice, see the separate instructions.Cat. No. 52810EForm 8038-CP (Rev. 1-2022)

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