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Form 8038-G <br />(Rev. September 2011) <br />Department of the Treasury <br />Internal Revenue Service <br />Information Return for Tax-Exempt Governmental Obligations <br />a Under Internal Revenue Code section 149(e) <br />a See separate instructions. <br />Caution: If the issue price is under $100,000, use Form 8038-GC. <br />OMB No. 1545-0720 <br />Part I Reporting Authority If Amended Return, check here a <br />1 Issuer’s name 2 Issuer’s employer identification number (EIN) <br />3a Name of person (other than issuer) with whom the IRS may communicate about this return (see instructions)3b Telephone number of other person shown on 3a <br />4 Number and street (or P.O. box if mail is not delivered to street address)Room/suite 5 Report number (For IRS Use Only) <br />3 <br />6 City, town, or post office, state, and ZIP code 7 Date of issue <br />8 Name of issue 9 CUSIP number <br />10a Name and title of officer or other employee of the issuer whom the IRS may call for more information (see <br />instructions) <br />10b Telephone number of officer or other <br />employee shown on 10a <br />Part II Type of Issue (enter the issue price). See the instructions and attach schedule. <br />11 Education ..............................11 <br />12 Health and hospital ..........................12 <br />13 Transportation ............................13 <br />14 Public safety .............................14 <br />15 Environment (including sewage bonds) ....................15 <br />16 Housing ..............................16 <br />17 Utilities ..............................17 <br />18 Other. Describe a 18 <br />19 If obligations are TANs or RANs, check only box 19a . . . . . . . . . . . . . <br />a <br />If obligations are BANs, check only box 19b . . . . . . . . . . . . . . . . <br />a <br />20 If obligations are in the form of a lease or installment sale, check box . . . . . . . . <br />a <br />Part III Description of Obligations. Complete for the entire issue for which this form is being filed. <br />21 <br />(a) Final maturity date (b) Issue price (c) Stated redemption <br />price at maturity <br />(d) Weighted <br />average maturity (e) Yield <br />$ $ years % <br />Part IV Uses of Proceeds of Bond Issue (including underwriters’ discount) <br />22 Proceeds used for accrued interest . . . . . . . . . . . . . . . . . . . . .22 <br />23 Issue price of entire issue (enter amount from line 21, column (b)) ...........23 <br />24 Proceeds used for bond issuance costs (including underwriters’ discount) . .24 <br />25 Proceeds used for credit enhancement ............25 <br />26 Proceeds allocated to reasonably required reserve or replacement fund .26 <br />27 Proceeds used to currently refund prior issues .........27 <br />28 Proceeds used to advance refund prior issues .........28 <br />29 Total (add lines 24 through 28) .......................29 <br />30 Nonrefunding proceeds of the issue (subtract line 29 from line 23 and enter amount here) . . .30 <br />Part V Description of Refunded Bonds. Complete this part only for refunding bonds. <br />31 Enter the remaining weighted average maturity of the bonds to be currently refunded .... a years <br />32 Enter the remaining weighted average maturity of the bonds to be advance refunded .... a years <br />33 Enter the last date on which the refunded bonds will be called (MM/DD/YYYY) ...... a <br />34 Enter the date(s) the refunded bonds were issued a (MM/DD/YYYY) <br />For Paperwork Reduction Act Notice, see separate instructions.Cat. No. 63773S Form 8038-G (Rev. 9-2011) <br />County of Kittitas 91-6001349 <br />Julie Kjorsvik, Clerk of the Board 509-962-7557 <br />205 West 5th Avenue 105 <br />Ellensburg, WA 98926 <br />Municipal Lease Purchase Agreement No.7768 None <br />Jerald V. Pettit, County Auditor 509-962-7557 <br />Election Equipment $149,773 00 <br />✔ <br />05/12/2021 149,773.00 N/A 2.785 3.295 <br />N/A <br />$149,773 00 <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />$149,773 00 <br />N/A <br />N/A <br />N/A