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HomeMy WebLinkAboutA021 - Form 8038-G, Information Return for Tax-Exempt Governmental obligations r Ames/419370-47 Form 8038-G Information Return for Tax-Exempt Governmental Obligations (Rev.September 2011) I►Under Internal Revenue Code section 149(e) OMB No.1545-0720 ►See separate instructions. Department of the Treasury Caution:If the issue price is under$100,000,use Form 8038-GC. Internal Revenue Service Reporting Authority If Amended Return,check here ► ❑ 2 Issuer's employer identification number(EIN) 1 Issuer's name 42-6004218 City of Ames,Iowa 3a Name of person(other than issuer)with whom the IRS may communicate about this return(see instructions) 3b Telephone number of other person shown on 3a 4 Number and street(or P.O.box if mail is not delivered to street address) T/suite 5 Report number(For IRS Use Only) 3 PO Box 811 7 Date of issue 6 City,town,or post office,state,and ZIP code November 16,2012 Ames,Iowa 50010-0811 9 CUSIP number 8 Name of issue None Sewer Revenue Bond,Series 2012 Telephone number of officer or other 10a Name and title of officer or other employee of the issuer whom the IRS may call for more information(see 10b employee shown on 10a instructions) Diane R.Voss,City Clerk 515-239-5105 Type of Issue (enter the issue price). See the instructions and attach schedule. 11 Education . . . . . . . . . . . . . . . . . . . . . . .i . . . . 11 12 Health and hospital . . . . . . . . . . . . . . . . . . . . . . 12 13 Transportation . . . . . . . . . . . . . . . . . . . . . . . . 13 14 Public safety . . . . . . . . . . . . . . . . . . . . . . . . . 14 15 Environment(including sewage bonds) . . . . . . . . . . . . . . . . 15 16 Housing . . . . . . . . . . . . . . . . . . . . . . 16 17 3,121,000 17 Utilities . . . . . . . . . . . . . • • • • • ' ' • ' 18 18 Other. Describe ► ► ❑19 If obligations are TANS or RANs,check only box 19a . . . . . . . . . . ► ❑If obligations are BANS,check only box 19b . . . . . . . . . . . . ► ❑20 If obligations are in the form of a lease or installment sale,check box . . . . . • . Description of Obligations. Complete for the entire issue for which this form is being filed. (c)Stated redemption (d)Weighted (e)Yield (a)Final maturity date (b)Issue price price at maturity average maturity 21 06-01-2032 3,121,000 3,121,000 11.7159 ears 1.750 % Uses of Proceeds of Bond Issue (including underwriters' discount) 122 22 Proceeds used for accrued interest . . . . . . . • • • • • j. 24 • 3,121,000 23 Issue price of entire issue(enter amount from line 21, column(b)) • • 1. . 24 Proceeds used for bond issuance costs(including underwriters'discount).25 Proceeds used for credit enhancement . . . . . . . . . . . 05 26 Proceeds allocated to reasonably required reserve or replacement fund27 Proceeds used to currently refund prior issues . . . . . . . .28 Proceeds used to advance refund prior issues . . . . . . . . 29 Total(add lines 24 through 28) . . . . . . . . . . . . . . . . . . . . . 29 15,605 30 Nonrefunding proceeds of the issue(subtract line 29 from line 23 and enter amount here) . . . 30 3,105,395 Description of Refunded Bonds.Complete this part only for refunding bonds. 31 Enter the remaining weighted average maturity of the bonds to be currently refunded . . . . ► years 32 Enter the remaining weighted average maturity of the bonds to be advance refunded . . . . ► Years 33 Enter the last date on which the refunded bonds will be called(MM/DD/YYYY) . . . • • • ► 34 Enter the dates the refunded bonds were issued►(MM/DD/YYYY) Form 8038-G(Rev.9-2011) For Paperwork Reduction Act Notice,see separate instructions. cat.No.63773S • a Form 8038-G(Rev.9-2011) Page 2 Miscellaneous 35 Enter the amount of the state volume cap allocated to the issue under section 141(b)(5) . . . . 35 36a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract (GIC)(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . 36a b Enter the final maturity date of the GIC► ' c Enter the name of the GIC provider► 37 Pooled financings: Enter the amount of the proceeds of this issue that are to be used to make loans ,.; to other governmental units . . . . . . . . . . . . . . . . . . . . . . . . 37 38a If this issue is a loan made from the proceeds of another tax-exempt issue,check box► ✓❑and enter the following information: b Enter the date of the master pool obligation► December 1,2011 c Enter the EIN of the issuer of the master pool obligation► 52-1699886 d Enter the name of the issuer of the master pool obligation► Iowa Finance Authority 39 If the issuer has designated the issue under section 265(b)(3)(13)(i)(III)(small issuer exception),check box . . . . ► ❑ 40 If the issuer has elected to pay a penalty in lieu of arbitrage rebate,check box . . . . . . . . . . . . . ► ❑ 41a If the issuer has identified a hedge,check here► ❑ and enter the following information: b Name of hedge provider Do- c Type of hedge► d Term of hedge► 42 If the issuer has superintegrated the hedge,check box . . . . . . . . . . . . . . . . . . . . 0- El 43 If the issuer has established written procedures to ensure that all nonqualified bonds of this issue are remedjated according to the requirements under the Code and Regulations(see instructions),check box . . . . . . . . ► ✓❑ 44 If the issuer has established written procedures to monitor the requirements of section 148,check box . . . . . ► 45a If some portion of the proceeds was used to reimburse expenditures,check here► ❑ and enter the amount of reimbursement . . . . . . . . . ► b Enter the date the official intent was adopted► Under penalties of perjury,I declare that I have examined this return and accompanying schedules and statements,and to the best of my knowledge Signature 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 and process t 's r turn,to th o`n/t ,t I have authorized above. Consent \ i,14 0, L �J Q _P� X 1� Diane R.Voss,City Clerk 'Signature of issuer's authorized representative Date 'Type or print name and title Print/Type preparer's name Pre arer's signature Date PTIN Paid �ri 2 Check ❑ if Amy Bjork J self-employed P01081072 Preparer 41-0223337 Use Only Firm's name ► Dorsey&Whitney I I P Firm's EIN ► Firms address ► 801 Grand Avenue,Suite 4100,Des Moines,Iowa 50309 Phone no. 515-283-1000 Form 8038-G(Rev.9-2011)