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Form 8038-G (Rev. 9-2011)Page 2 <br />Part VI Miscellaneous <br />35 Enter the amount of the state volume cap allocated to the issue under section 141(b)(5) ....35 <br /> 36 a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract <br />(GIC) (see instructions) .........................36a <br />b Enter the final maturity date of the GIC a <br />c Enter the name of the GIC provider a <br />37 Pooled financings: Enter the amount of the proceeds of this issue that are to be used to make loans <br />to other governmental units ........................37 <br />38 a If this issue is a loan made from the proceeds of another tax-exempt issue, check box a and enter the following information: <br />b Enter the date of the master pool obligation a <br />c Enter the EIN of the issuer of the master pool obligation a <br />d Enter the name of the issuer of the master pool obligation a <br />39 If the issuer has designated the issue under section 265(b)(3)(B)(i)(III) (small issuer exception), check box .... <br />a <br />40 If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check box ............. <br />a <br />41 a If the issuer has identified a hedge, check here a and enter the following information: <br />b Name of hedge provider a <br />c Type of hedge a <br />d Term of hedge a <br />42 If the issuer has superintegrated the hedge, check box ..................... <br />a <br />43 If the issuer has established written procedures to ensure that all nonqualified bonds of this issue are remediated <br />according to the requirements under the Code and Regulations (see instructions), check box ........ <br />a <br />44 If the issuer has established written procedures to monitor the requirements of section 148, check box ..... <br />a <br />45a If some portion of the proceeds was used to reimburse expenditures, check here a and enter the amount <br />of reimbursement ......... a <br />b Enter the date the official intent was adopted a <br />Signature <br />and <br />Consent <br />Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge <br />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 <br />process this return, to the person that I have authorized above.FSignature of issuer’s authorized representative Date FType or print name and title <br />Paid <br />Preparer <br />Use Only <br />Print/Type preparer’s name Preparer's signature Date Check if <br />self-employed <br />PTIN <br />Firm’s name a <br />Firm's address a <br />Firm's EIN a <br />Phone no. <br />Form 8038-G (Rev. 9-2011) <br />✔ <br />Jerald V. Pettit, County Auditor