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Fo<m 6090 -r3 (Rev.9 20 11) Page 2 <br />Miscellaneous <br />35 Enter the amount of the state the Issue under section 14 1 <br />36a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment 35 <br />contract <br />volume ca 111ocat�d to <br />(GIC) (see Instructions) 360 <br />b Enter the final maturity date of the GIC ► — <br />C Enter the name of the GIC provider ► <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 . . . . . . . . . . . . . . . . . . . . . . . 137 <br />38a <br />Is <br />39 <br />40 <br />41a <br />If this issue is a loan made from the proceeds of another tax - exempt issue, check box P. ❑ and enter the following <br />Enter the date of the master pool obligation ► <br />Enter the EIN of the issuer of the master pool obligation ► _�� — <br />Enter the name of the issuer of the master pool obligation Ili- <br />If the issuer has designated the issue under section 265(b)(3)(B)(i)(II1) (small issuer exception), check box <br />If the issuer has elected to pay a penalty In lieu of arbitrage rebate, check box . . . . . . . . <br />If the issuer has identified a hedge, check here Iii ❑ and enter the following information: <br />► ❑ <br />► O <br />Is Name of hedge provider► <br />is Type of hedge lie _y -s- - - -` <br />d Term of hedge ► _ __ <br />42 If the issuer has superintegrated the herJge, check box . . . . . . . . . . . . . . . . . . . . . ► ❑ <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 />44 If the issuer has established written procedures to monitor the requirements of section 148, check box . ► ❑ <br />45a If some portion of the proceeds was used to reimburse expenditures, check here ► ❑ and enter the amount <br />of reimbursement . . . . . . . . . ► <br />Enter the date the official intent was adopted ► <br />Untler penalties of perjury. I declare :hat I nave assmlaed this return and accompanying schedules and statements. and to the best of my knowledge <br />Signature and belles, 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 />and process this return, to the person that I have authorized oho" <br />Consent <br />Sign ilcre of Issuer's authorzed representative — Da:e T _ Type or print name and title — <br />PdntrType preparer's name Preparer's signature Data PTiN <br />Paid II Cnacx ❑ if <br />- -_ __.._ ... — —___- _- -- -.— eu- employed Use Only Firm's name y_ _Firm s EIN <br />Firm's address Rhona no, <br />Form 8038 -G (Rev, 9-201 1) <br />