ORDER N0.29064
LEASE PURCHASE OF
CHIPSPREADER AND ASPHALT DISTRIBUTOR
WITH SECURITY STATE BANK AND TRUST
On this the 28"' day of February 2005, upon motion made by Commissioner Baldwin,
seconded by Commissioner Williams, the Court unanimously approved by a vote of 4-0-
0, the lease purchase of chip spreader and asphalt distributor and lease document with
Security State Bank and Trust and authorize the County Judge to sign same.
I.3~
COMMISSIONERS' COURT AGENDA REQUEST
PLEASE FURNISH ONE ORIGINAL AND NINE COPIES OF THIS
REQUEST AND DOCUMENTS TO BE REVIEWED BY THE COURT.
MADE BY: ~ m '~" ~ ~~ ~ ~' ~~ s9-~ OFFICE: T7 v`~~~r
MEETING DATE:.Z - a ~ ~ TIME PREFERRED:
SUBJECT: ~'a'vi+=~'cY•~- gy}d c>/i'scl/s~ ~~pse ~/!'O/~~f C~ ~~~~
c~ ~~ c~ half' c~r'~ f /'i;~~~rd ~t~p~/'~ leap ~o~v~'ri.
Saw~~~•~ ~fafe ~~nk ~ Tr ~f ~t-•Z••' cz~~hvr•'~-E' ~v/jfy ~~Q
fv s. ~ n s~'~•
EXECUTIVE SESSION REQUESTED: (PLEASE STATE REASON)
NAME OF PERSON ADDRESSING THE COURT:
ESTIMATED LENGTH OF PRESENTATION:
d~J `' ,~
~.. ..,.%~ ._. j
IF PERSONNEL MATTER -NAME OF EMPLOYEE:
Time for submitting this request for Court to assure that the matter is posted in
accordance with Title 5, Chapter 551 and 552, Government Code, is as follows:
Meeting scheduled for Mondays: 5:00 P.M. previous Tuesday.
THIS REQUEST RECEIVED BY:
THIS REQUEST RECENED ON:

All Agenda Requests will be screened by the County Judge's Office to determine if adequate
information has been prepared for the Court's formal consideration and action at time of Court
Meetings. Your cooperation will be appreciated and contribute towards you request being
addressed at the earliest opportunity. See Agenda Request Rules Adopted by Commissioners'
Court.
Documentation Instructions
The instructions listed below should be followed when completing the enclosed documentation. Documentation completed
improperly wiN delay funding. If you have any questions regarding the instructions or the documentation, please call us.
I. LEASE WITH OPTION TO PURCHASE AGREEMENT
EXCEPT AS NOTED, ALL SIGNATURES MUST BE BY THE PERSON OR PERSONS AUTHORIZED /N EXH/B1T E
1. The Agreement
• Sign and type name and title
2. Exhibit A -DESCRIPTION OF EQUIPMENT
• Type in complete equipment description
• Type the location where the equipment will be located after delivery/installation.
3. Exhibit B -PAYMENT SCHEDULE
• Sign and type name and title
4. Exhibit C -CERTIFICATE OF ACCEPTANCE
• Type in essential use of equipment
• Sign and type name and title
5. Exhibit D -OPINION OF COUNSEL
• Request that your legal counsel complete the opinion of counsel section by retyping the example given on
his/her letterhead with their signature.
• Legal counsel shall not alter the opinion.
6. Exhibit E -LESSEE RESOLUTION
• Type in the date of the meeting in which the purchase was approved.
• Print or type the name and title of the individual(s) who is authorized to execute the Agreement
• The secretary, chairman or other authorized board member of the Lessee must sign the
resolution where indicated.
• A third individual must attest the Resolution where indicated.
7. Exhibit F, BANK QUALIFIED CERTIFICATE
• Sign and type name and title
II. 8038 -IRS Form
~~ In Box 2, type employer identification number
`~ Sign and type name and title
III. CERTIFICATE OF INSURANCE
^ Attach a written certificate (binder) of proof of insurance with
ecurit tate Bank Tr t as "loss payee" and `additional insured"
^ This certificate MUST be an original certificate
^ SEE ATTACHED INSURANCE REQUIREMENTS
IV. ADDITIONAL DOCUMENTATION THAT MUST BE SENT TO Security State Bank & Trust:
^ Original vendor invoice (if applicable)
^ Copy of title/MSO listing Security State Bank & Trust as 1 st lienholder (if applicable)
^ First payment check (if applicable)
All documentation should be returned to:
Security State Bank & Trust, 1130 Junction Highway, Kerrville, Texas 78028
~'

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Schedule (01)
EXHIBIT A
DESCRIPTION OF EQUIPMENT
RE: Lease With Option to Purchase Agreement dated as of March 1, 2005, between Security State Bank & Trust
(Lessor) and Ken- County (Lessee)
Below is a detailed description of all the items of Equipment induding quantity, model number and serial number where
applicable:
Etnyre Chipspreader, Serial # K6079
Location of Equipment: 4010 San Antonio Hwy. , Kerrville, TX 78028
Schedule (02)
EXHIBIT A
DESCRIPTION Of= EQUIPMENT
RE: Lease VYith Option to Purchase Agreement dated as of March 1, 2005, between Security State Bank ~ Trust
(Lessor) and Kerr County (Lessee)
Below is a detailed description of alI the items of Equipment induding quantity, model number and serial number where
applicable:
Asphalt Distributor, Serial # 51830
location of Equipment: 4010 San Antonio Hwy. , Kerrville, TX 78028
Schedule (01)
EXHIBIT B
PAYMENT SCHEDULE
RE: Lease nth option to Purchase Agreement dated as of March 1, 2005, between Security State Bank 8 Trust
(Lessor) and Kerr County (Lessee)
Date of First Payment: March 1, 2006
Original Balance: $182,398.00
Total Number of Payments: Three (3)
Number of Payments Per Year. One (1)
Pmt	Due	Rental	Applied to	Applied to	*Purchase
No.	Date	Payment	Interest	Principal	Option Price
1	1-Mar-06	$66,101.43	$7,843.11	$58,258.32	$124,139.68
2	1-Mar-07	$66,101.43	$5,338.01	$60,763.42	$63,376.26
3	1-Mar-08	$66,101.43	$2,725.17	$63,376.26	$0.00
K
Signature
a~ r, I C~-,y.~.
Typed Name and Title
'Assumes aH Rental Payments due to date are paid
Schedule (02)
EXHIBIT B
PAYMENT SCHEDULE
Option to Purchase Agreement dated as of March 1, 2005, between Security State Bank & Trust
. County (Lessee)
Date of first Payment: March 1, 2006
Original Balance: $49,500.00
Total Number of Payments: Three (3)
Number of Payments Per Year. One (1)
-.:.t Due	Rental	Applied to	Applied to	*Purchase
:~:v. Date	Payment	Interest	Principal	Option Price
1-Mar-O6	$17,938.91	$2,128.50	$15,810.41	$33,689.59
_ 1-Mar-07	$17,938.91	$1,448.65	$16,490.26	$17,199.33
1-Mar-08	$17,938.91	$739.58	$17,199.33	$0.00
--r J ~.
- - - - - - ; ills
w
-s= is due to date are paid
Schedule (01)
EXHIBIT C
CERTIFICATE OF ACCEPTANCE
RE: Lease With Option to Purchase Agreement dated as of March 1, 2005, between Security State Bank 8 Trust
(Lessor) and Kerr County (Lessee)
I, the undersigned, hereby certify that I am a duly qualified representative of Lessee and that I have been given the authority
by the Governing Body of Lessee to sign this Certificate of Acceptance with respect to the above referenced Agreement. I
hereby certify that:
1. The Equipment described on Exhibit A has been delivered and installed in accordance with Lessee's specfications.
2. Lessee has conducted such inspection and/or testing of the Equipment as it deems necessary and appropriate and
hereby acknowledges that it accepts the Equipment for all purposes.
3. Lessee has appropriated and/or taken other lawful actions necessary to provide moneys suffiaent to pay all Rental
Payments required to be paid under the Agreement during the current Budget Year of Lessee, and such moneys will
be applied in payment of all Rental Payments due and payable during such current Budget Year.
4. Lessee has obtained insurance coverage as required under the Agreement from an insurer qualified to do business
in the State.
5. Lessee is exempt from all personal property taxes and is also exempt from sales and/or use taxes with respect to the
Equipment and the Rental Payments.
6. No event or condition that constitutes or would constitute an Event of Default exists as of the date hereof.
7. The governing body of Lessee has approved the authorization, execution and delivery of this A reement on its behalf
by the authorized representative of Lessee who signed the Agreement. _
8. During the term of fhe Agreement, the Equipment will be used for essential govern .Such functions
are:
Please list the Source of Funds {Fund item in Budget) for the Rental Payments that oorr>r< hibit B of this
Agreement.
1(?. Please state why you reasonably expect and anticipate that adequate funds will be avai ental
Payments that will come due under Exhibit B.
Sgnature
1ti
Typed Name and Tide
Schedule (02)
EXHIBIT C
CERTIFICATE OF ACCEPTANCE
RE: Lease With Option to Purchase Agnaement dated as of March 1, 2005, between Security State Bank & Trust
(Lessor) and Kerr County (Lessee)
I, the undersigned, hereby oertiTZr that I am a duly qualified representative of Lessee and that 1 have been given the authority
by the Governing Body of Lessee to sign this Certficate of Acceptance with respect to the above referenced Agreement. I
hereby certify that:
1. The Equipment described on Exhibit A has been delivered and installed in accordance with Lessee's specifications.
2. Lessee has conducted such inspection and/or testing of the Equipment as it deems necessary and appropriate and
hereby acknowledges that it accepts the Equipment for all purposes.
3. Lessee has appropriated and/or taken other lawful actions necessary to provide moneys suffiaent to pay all Rental
Payments required to be paid under the Agreement during the current Budget Year of Lessee, and such moneys wilt
be applied in payment of all Rental Payments due and payable during such current Budget Year.
4. Lessee has obtained insurance coverage as required under the Agreement from an insurer qualfied to do business
in the State.
5. Lessee is exempt from all personal property taxes and is also exempt from sales and/or use taxes with respect to the
Equipment and the Rental Payments.
6. No event or condition that constitutes or would constitute an Event of Default exists as of the date hereof.
7. The governing body of Lessee has approved the authorization, execution and delivery of this Agree s behalf
by the authorized representative of Lessee who signed the Agreement.
8. During the term of the Agreement, the Equipment wilt be used for essential governmental lions
are:
9. Please list the Soun~e of Funds (Fund Item in Budget) for the Rental Payments that come due this
Agreement.
10. Please state why you reasonably expect and anticipate that adequate funds will be avails tal
Payments that will come due under Exhibit B.
`.
Signature
~--~t- ` n
Typed Name and Title
EXHIBIT D
OPINION OF COUNSEL
(Must be Re-tvaed onto attorney's letterhead)
(Date, must be on or after the meeting date listed on Exhibit E, Lessee Resolution)
Security State Bank Z~ Trust
1130 Junction Highway
KerrviNe, Texas 78028
RE: Lease With Option to Purchase Agreement dated as of March 1, 2005, between Security State Bank 8 Trust
(Lessor) and Kerr County -Schedule 01 ~ 02 (Lessee)
Ladies and Gentlemen:
As legal counsel to Lessee, I have examined the foregoing Agreement and such other opinions, documents and matters of
law as I have deemed necessary in connection with this Agreement. Based on the foregoing, I am of the following opinions:
1. Lessee is a political subdivision of the State of Texas, or a constituted authority authorized to issue obligations on behaff
of a political subdivision of the State.
2. Lessee has the requisite power and authority to purchase the Equipment and to execute and deliver the Agreement and
to perform its obligations under the Agreement. The Agreement and the other documents either attached hereto or
required herein have been duly authorized, approved and executed by and on behalf of Lessee, and the Agreement is a
legal, valid and binding obligation of Lessee enforceable in accordance with its terms.
3. The authorization, approval and execution of the Agreement and all other proceedings of Lessee relating to the
transactions contemplated thereby have been performed in accordance with all open meeting laws, public bidding laws
and all other applicable state and federal laws.
4. There is no litigation, action, suit or proceeding pending or before any court, administrative agency, arbitrator or
governmental body that chaNenges the authority of the Lessee or any of the Lessee's officers or employees to enter into
the Agreements.
5. The above opinion is for the sole benefit of the Lessor listed above and can onty be relied upon by the Lessor or any
permitted assignee or subassignee of Lessor under the agreement.
Signature of Legal Counsel
Schedule (01 $ 02)
EXHIBIT E
LESSEE RESOLUTION
use With Option to Purchase Agreement dated as of March 1, 2005, between Security State Bank & Trust
and Kerr County (Leases)
At a duly called meeting of the Goveming Body of the Lessee (as defined in the Agreement) held on
February 28 , 2005 the following resolution was introduced and adopted:
BE IT RESOLVED by the Goveming Body of Lessee as folkwvs:
1. Determination of Need. The Goveming Body of Lessee has determined that a true and very real need exists for the
acquisition of the Equipment described on Exhibit A ~ the Lease nth Option to Purchase Agreement dated as of March
1, 2005, between Kerr County (lessee) and Security State Bank & Trust (Lessor).
2.
Approval and Authorization. The Goveming Body of Lessee has determined that the Agreement, substantially in the
form presented to this meeting, is i the best interests of the Lessee for the acquisition of such Equipment, and the
Goveming Body hereby appro entering into of the Agreement by the Lessee and hereby designates and
authorizes the fo8owing pe to and deliver the Agreement on Lessee's behalf with such changes thereto
as such persons} deem( any related documents, including any Escrow Agreement, necessary to the
consummation of the tra mptated by the Agreement,
Auttnorized Individual(s) Kerr County
(Printed or Typed Name and Title of individual(s) authored to execute the Agreement)
3. Adoption of Resolution. The sgnatures below from the designated individuals from the Goveming Body of the Lessee
evidence the adoption by the Goveming Body of this Resolution.

(Signature
Typed Name S Title
Ryles

iry, t3oard Chairman or other member of the
~t ~ ', ~LQ.... Cam,,
of individual who signed directly above)
Attested By: - Y ~ ~ ~-~ _ ~ ` ~ T~r~~'71.~rY
(Signature of one additional person who can witness the passage of this
Typed Name 8~ Title: NadenP Alford Detou ,y County Clerk
(Typed name of individual who signed directly above)
Schedule (01 & 02)
EXHIBIT F
BANK QUALIFIED CERTIFICATE
RE: Lease With Option to Purchase Agreement dated as of March 1, 2005, between Security State Bank 8 Trust
(Lessor) and Kerr Countv (Lessee)
Whereas, Lessee hereby represents that it is a "Bank Qualified" Issuer for the calendar year in which this Agreement is
executed by making the fdlowing designations with rasped to Section 265 of the Intemal Revenue Code. (A "Bank Qualified
Issuer" is an issuer that issues less than ten million ($10,000,000) dollars of tax-exempt obligations during the calendar year).
Now, therefor, Lessee hereby designates this Agreement as follows:
1. Designation as Qualified Tax-Exempt Obligation. Pursuant to Section 265(b)(3xBxi) of the Internal Revenue Code of
1986 as amended (the "Code"), the Lessee hereby specifically designates the Agreement as a °qualified tax-exempt
obligation' for purposes of Section 265(bx3) of the Code. In compliance with Section 265(bx3xD) of the Code, the
Lessee hereby represents that the Lessee will not designate more than $10,000,000 of obligations issued by the Lessee
in the calendar year during which tha Agreement is executed and delivered as such 'qualified tax-exempt obligations".
2. Issuance Limitation. In compliance with the requirements of Section 265(bx3xC) of the Code, the Lessee hereby
represents that the Lessee (including all subordinate entities of the Lessee within the meaning of Section 265(b)(3xE) of
the Code) reasonably anticipates not to issue in the calendar year during which the Agreement is executed and
delivered, obligations bearing interest exempt from federal income taxation under Section 103 of the Code (other than
"private a ity bonds" as defined in Section 141 of the Code) in an amount greater than $10,000,000.
r
Signature
Typed Name and Title
INSURANCE REQUIREMENTS
Pursuant to Article V in the Lease With Option to Purchase Agreement, you have agreed to provide us evidence
of insurance covering the property in the Agreement. A Certificate of Insurance naming all insured parties and
coverages must be determined to us as soon as possible, but no later than the date on which delivery of
equipment occurs. If you have not taken~ossession of the equipment, please write a memo to Security State
Bank & Trust statingyour carrier insurance agent and telephone number to reach them uvon delivery.
In the case of self-insurance, the amounts of liability and physical damage coverage are to be listed on some
form of certificate supplied by you. In addition, information regarding the nature of your self-insurance
program should also be forwarded to us as soon as possible.
INSURANCE REQUIREMENTS BY SECURITY STATE BANK & TRUST:
1. LIABILITY
/ Minimum of $1,000,000.00 combined single-limit on bodily injury and property damage.
/ Security State Bank £~ Trust MUST be listed as additional insured and loss payee.
2 PHYSICAL DAMAGE
/ All risk coverage to guarantee proceeds suffccient to pay the applicable Purchase Option Price as set forth in
Exhibit B of the Agreement. Security State Bank & Trust MUST be listed as additional insured and loss payee.
3. ENDORSEMENT
/ Lessor wilt receive at least thirty (30) days written notice from Insurer prior to alteration, cancellation or
reduction of insurance coverage.
PLEASE FAX THE CERTIFICATE TO US AS SOON AS POSSIBLE AT (830) 895-2012, AND MAIL THE
ORIGINAL TO:
Security State Bank & Trust
1130 Junction Highway
Kerrville, Texas 78028
YOUR ASSISTANCE IS GREATLY PRECIATED TO COMPLETE THIS TRANSACTION, IF YOU HAVE
ANY QUESTIONS, PLEASE G A CALL AT 830 895-2000.
Kerr County
Insurance Company:
Agent's Name:
Telephone #:
Fax #:
Address, City, State Z~ Zip:
Fanrt $Q3$-r3 ~ Information Retum for Tax-Exempt Govemmentat Obligations I a+nB No.15a~o72o
(Rev. Noverrlber 200D) D Under lrutemal Revenue Code section 149(e)
os~.,u,,,,,, a tlr r,~.Y D See separate instructions
trrernd Re`en,e sanioe
(C.albOrl: else Faun Bo38-GC kC~e rssue price rs under Stogooo.)
• Reporting Autltority tr /lrtterxia+t Return, ctreck here ^
1. Issuer's nerrle 2. Issuers enplayer IderAificafion rxmi~er
Kerr (:nunty ~
3 Number and s4eat {a PO Ban if mail is not delivered b street address)
700 Main Street	Rnorn/Sulte		4. FLaport nxnber
3 OS - 01
S Gly. town, a post duce. abate, and ZIP code
Kerrville, Texas 78028			6. Dale d issue
03-O1-05
7. Nerve d issue
Lease with lion to Purchase A went			8. iX1SIP nub
None
and title of a legal representatne whom the I may call for more information
Totem Tomlinson	0. Telephone no. of officer or legal representative
Type of Issue (check applicable box(es)) and enter the issue price) See insbnx~orts a	attach s	chedu	le
11. ^ Education		11	
12. ^ Health and hospital		1	
13. ^ Transportation .		13	
14
^ t~utblic safely		14	
.
15. ^ Elrvir+onrrtant (inducting sewage bonds)		15	
16. ^ Housing		1fi	
17. ^ Utilities		17	
18. ® Other, Describe - Etnvre Cttiosoreader
19. ff obligations are TANs a RANs, check box - ^ If obligations are BANS, check box - ^
20. k obligations are in the form of a lease or installment sale, check box -®	18	$182,398.00
of Obligations (Complete for the entire issue for which this laorrri is being filed.)
(a) Feel Metuity date (b) Issue prbe (c) Slated redertlpdon Price at rtra4ritY (di Weigtlled avg, rrrednily
21. 03-01-08 $182,396.00 $ WA Three (3) Years
• Uses of Proceeds of Bond Issue (including underwriters' discount) N!A
22. Proceeds used for aixnted interest . 22
23. Issue price of entire issue (enter amount from Gee 21, column (b)) 23
24. Proceeds used for bond issuance ousts (lnduding underwriters' discount) .
25. Proceeds used for credit enhancement
2fi. Proceeds aAor~ted fd reasonably regtbred reserve or replaoerrtent furxl .
27. Ptocseds used to currently refund prior issues.
28. Proceeds used b advance rotund prior issutes
29. Total (add irtes 24 ~rtwgh 28) . 29
30. Nortrefitrtdirtg proceeds of tt-e issue (subtract line 29 from Nee 23 and enter anxwrtt here) .
• .. Description of Re{utrtded Bonds tcomplebe this part onhr for refuxrding bonds) WA
(e) Yreid
31. Enter the remaining weighed average maturity of the bonds b be currently refunded - years
32 Enter the rerrtainirtg weighed average maturity of the bonds b be advance refixtded - years
33. Enter the fast dabs txt which the refunded bortris will be calved -
34. Enter the date(s) the refunded bords were issued -
tMisrxllarreous
35. Enter the amourut h the state volume cap aNocated b the issue under section 141(bx5) . 35
3fi a Enter the arrant of gross pooeecis irtrested a b be i~rMesied in a guaranteed iives*rierit contract (see IneruaiQ,s)) 36a
b Enter the final mahxity date of the guaranteed investment contract - ~~ ~t
37. Pooled finarxtings: (a) Proceeds of tiffs issue that are b be used b make loans to other goverrurtenta! units
b H this issue is a ban made from the proceeds of another tax~xempt issue, check box - ^ and enter the name of the issuer
y and the date of the issue -
38. ff the issuer has tiesigrta the issue utder section ZG5(bx3x6)[xfll) (small issuer exception, t~teck box . -
39. H the issuer has a penalty in lieu of arbitrage rebate, check box - ^
40. !f issuer has ' check box . -
Uptrtder . I deflate t ~t t m> ~~r~eh' xn and aooompenyng sc'heduies and statements. and, to the t,esc
my ,they
Please
Sign
Here
Signs s authorized representative Type or print Warne and title
t=aut 8038-GC
(Rev. November 2000)
of the Treasury
ktern0l Rersrtr0 Senioe
Information Return for Small Tax~xempt
Governmental Bond Issues, Leases, and InstaNment Sales
t.klder YXerrtel Retierrie Code section 149(e)
OMB No. 1545-0720
GtMlon: U9e Form B03B-G if the fes~ia prloe of the issue is 5100,000 ar more.
• . Rnnnr4inn de4hevily ClrarJc hrnr iFArrrerded Rehm n
1, lerrefs rertre	2 4wrrefa iderYifireliorr romper
Kerr County	
3 Wurrber and atreA (or PO eoz d mail is not detiverad b street a0~ess)	RoorrVSriae
7001V1a1II Strrret	
4. (]ry. bwn, or poet office, state, and aP Dods	5. Report nan6er
Kerrville, Texas 78028	5 OS-02
e. htalre and Hle of oficer or legal mpreaersative whom the IRS may call for om vsorrnertion	7. 7elephdre number of otrieer or Iegal represersatire
Tommy Tomlinson	( )
of t3bf s (Check rf : a issue or on a consolidated basis )
tie Issue price of obligation(s) (see instnx~ions) . .. Sa $ 49,500.00
b Issue date (single issue) or calendar year (consdidated) (see insinx.-tiorts) 03/01 /05
9 Amount of the reported obligation(s) on lase 8a:
a Used bo rteftxxi prior issue(s) .. .. 9a
b Representing a loan from the proceeds ofanothertax-exempt obggation (e.g., bond bank) .. 9b
10 ff the issuer has designated any issue under section 265(bx3xBxix111) (small issuer exception), check ittis box ..
11 ff any odigation is in of a lease or installment sate, check this box
..............
12 ff the issuer has a nal in lieu of arbi rebate, check this box -
Urtder , 1 declare that I have examited this return and aocornpertying sciledulPS and statements, and, to the Lest of my
,they are true, otxreci, and txxrtplete.
Please / _
Sign - ""."--' b~
Here ~.+ 1 ~l~~r
Isatrers Dale Type o<pr'ws name and title
1NSTRUCTfONS
Section rt~ierenaes are to ttre tlternal Revenue
Coot unAess otherwise noted.
Purpose of Form
Form 8038-GC is teed by the issuers oftax-exempt
governmerrtal obigations id provide the IRS with
intonrtation required by sec.~lion 149(e) and >a
monitor the requirements of sections 141-150.
Who Must Fife
Issuers oftax-exempt govenrnenial obigatiarrs with
issue prices of less than 5100.000 must file Forrrl
ti038-CaC. Issuers of a tax~xentpt govern-mental
obligation with an issue price of 5100,000 or more
must file Forth 8038-G, IrNbrtnebrxr Rtatum Sot Tax-
Exempt Governnrentai t?bfige(ions.
FlNng a separate rehm--fi+suers have the option bo
file a separate f=orm 8t)3&GC for arty tax$rcempt
gOVefrMrlerrt~ Ob~gatlOn With 8tl 155U9 price Of 1955
than $100,000.
An issuer of a tax~xempt bond used to firtartce
oonstrur.~tiort expenditures must fle a separate Forth
8038-GC for each issue to give notice to the NtS th9t
an eleciior- was marts to pay a penaNy ~ feu of
arbitrage rebate (aee the lire 12 instructions).
FlUng a aortsolldated return-For all tax~xempt
garernmerrtal obligations wNh ensue prices of less
than 5100,aoo that are not reported on a separate
Form 8036-GC, an issuer must tie a oor~soidated
irr(omnation return itckrding a1 such issues issued
within the calendar year.
Thus. an issuer may file a separate Form 8038-GC
for each of a number of smatl issues and report the
remainder of smaN issues issued during the calendar
year an one consafidated Form 8038-GC. However,
a separate Forrn 8038-GC must be tied th give the
IRS rtoiice of the election ifl pay a penalty in lieu of
arbitrage rebate.
When to File
To file a separate rahxn, file Farm 60311-GC on or
betas the 15° day of 1ha setxxtd calendar matth
almer the dose of the calendar quarter in which the
issue is issued.
To tie a t:a~io11da1ed re4tm, flie Form8038-GC on
or before February 15° of the calendar year in which
the Issue is ensued.
labs flltrtg. An issuer may be granted an extension
of time m lie Faun 8036-GC under Ser.-tion 3 of Rev.
Prot. 88-10,1968-1 CB.635, if it is detemuned that
the faiure to file on times not due to wilful neglect.
Type or print at the thP of the form. "This Statement
is Strbrrtitted a Accordance with Rev. Prot. 68-10'
Attach to the Farm 8038-GC a letter briefly stating
why the form was hat submitted to the i2S on 13me.
Also indicate whether the obigation it question is
under examination by the IR,S. Do not submit txlpi9s
of art)+ bond doarrnertts, leases. ar irtstaitnent sale
docurt-ents.
Whet+e to File
File Form 8038-GC wih the kderslal ReverNile
Service Center, Ogden. UT 84201.
Other Forms that May be Required
For rebating a~9e (a P0Y~9 a penally in fieu of
arbitrage rebate) to the Federal govertxrlerrt, use
Forth 8038-T, Arbitrage Rebate and Ponally in Lieu
of Arbitrage Rebate. Far private at~vily bonds. use
Forth 8038, Nrfarnratan Return for Tax-Exempt
Rivets Activity Bond issues
Rounding to Whole Dollars
You may show the money items on this return as
wttoleiioiar amaxrts. To do so, drop any amount
less than 50 otrr-ts and eftcrease arty amount ftorn 50
cents through 99 cents b the next higher dollar.
Definitions
Obliys49otts_ imtis refers 1b a s~tgle tax-exempt
goverrtrrterrlal abigation ffForth 8038-GC is used for
separate reporting or fA multiple tax~xempt
goverrsrterrhdl abigatiorts "rf the Icon is used for
oortsoidated reporting.
Taz-attempt obligatlon. This is a bond. insiaNment
pta>;Ftase agreement, or ftrtandal lease, on which
ttte Urterest'ts exdtxted from itcartte under sedan
103.
Tax~xempt goverrMrental oWlgatlon. A tax-
exempt abigation that is rat a private acOvity bond,
(see below) is a tax~xempt go+remmerttal obigation.
Tins irldudes a bond issued by a quaified volunteer
fire dtspartrnent under section 150(e).
Private at*ivKy bond This indtxies an obligation
issued a5 part of an issue in which:
Mora than 1096 of the proceeds are to be used for
any private adivily btrsiless use