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Form 8038-G (Rev. 9-2011) <br />Page 2 <br />iffLial <br />Miscellaneous <br />35 <br />Enter the amount of the state volume cap allocated to the issue under section 141(b)(5) . . . . <br />35 <br />0 <br />36a <br />Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract <br />(GIC) (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . <br />36a <br />0 <br />b <br />Enter the final maturity date of the GIC ► <br />c <br />Enter the name of the GIC provider ► <br />37 <br />Pooled financings: Enter the amount of the proceeds of this issue that are to be used to make loans <br />to other governmental units . . . . . . . . . . . . . . . . . . . . . . . <br />37 <br />0 <br />38a <br />If this issue is a loan made from the proceeds of another tax-exempt issue, check box ► ❑ and enter the following <br />information: <br />b <br />Enter the date of the master pool obligation ► <br />c <br />Enter the EIN of the issuer of the master pool obligation ► <br />d <br />Enter the name of the issuer of the master pool obligation ► <br />39 <br />If the issuer has designated the issue under section 265(b)(3)(13)(1)(111) (small issuer exception), check box . . . <br />. ► ❑ <br />40 <br />If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check box . . . . . . . . . . . . <br />. ► ❑✓ <br />41a <br />If the issuer has identified a hedge, check here ► ❑ and enter the following information: <br />b <br />Name of hedge provider ► <br />c <br />Type of hedge ► <br />d <br />Term of hedge ► <br />42 <br />If the issuer has superintegrated the hedge, check box . . . . . . . . . . . . . . . . . . <br />. ► ❑ <br />43 <br />If the issuer has established written procedui �nnnttalified bonds of this issue are remediated <br />according to the requirements under the Code,, )ck box . . . . . . . <br />. ► 0 <br />44 <br />If the issuer has established written procedures <br />h 148, check box . <br />► ❑✓ <br />45a <br />If some portion of the proceeds was used to re (L U� <br />" <br />❑ and enter the amount <br />of reimbursement . . . . . . . . . ► I <br />b <br />Enter the date the official intent was adopted <br />Under penalties of perjury, I declare that I have e s and statements, and to the best of my knowledge <br />Signature and belief, they are true, correct, and complete. I sure of the Issuer's return information, as necessary to <br />and process this return, to the person that I have aut <br />Consent &z644 Tom Kelly, Treasurer <br />' Signature of issuer's au ized r resentative e ' Type or print name and title <br />Paid Print/7ype preparer's name Preparer's signature Date Check ❑ if PTIN <br />Preparer JGina A. Fiorini self-employed P01702051 <br />Use Only Firm's name ► Kennedy & Graven, Chartered Firm's EIN ► 41-1225694 <br />Firm's address ► 200 South 6th Street, Ste 470, Mpls, MN 55402 Phone no. 612-337-9300 <br />Form 8038-G (Rev. 9-2011) <br />