Tab_80e
Form 8038-G I Information Return for Tax-Exempt Governmental Obligations I
(Rev. September 2011) Under Internal Revenue Code section 149(e) OMB No. 1545-0720 See separate instructions. Department of the TreasuryI
internal Revenue Service Caution: If the issue price is under $100,000, use Form 8038-GC.
Renortina Authority
1 Issuers name - 2 Issuers employer Identification number (BIN)
City of Bethel, Alaska 92-6001644
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
4 Number and street (or P.O. box If mail Is not delivered to street address) Roorrilsuite 5 Report number (For IRS Use Only)
P.O. Box 1388 I
6 City, town, or post office, state, and ZIP code 7 Date of Issue
Bethel, Alaska 99559 November 3, 2016
8 Maine of issue 9 CIJSIP number
Lease Revenue Refunding Bond, 2016 None
10a Name and title of officer or other employee of the issuer whom the IRS may call for more information (see lOb Telephone number of officer or other
Instructions) employee shown on 1 D
Hansel L. Mathlaw, Finance Director (907) 543-2047
I Tvoe of Issue (enter the issue once). See the instructions and attach schedule.
11 Education ..............................
12 Health and hospital
13 Transportation ............................
14 Public safety .............................
15 Environment (including sewage bonds) ....................
16 Housing ..............................
17 Utilities
18 Other. Describe court complex refunding
19 If obligations are TANs or RANs, check only box 19a ............. 0
If obligations are BANS, check only box 19b .................0
20 If obligations are in the form of a lease or installment sale, check box ......... 0
2,327,897
Final maturity date (b) Issue price (c) Stated redemption
price at maturity
(d) Weighted
I average maturity (e) Yield I
12/01/2027 $ 2,327,897 $ 2,000,000J 7.0874 years I 2.5984 %
__Uses of Proceeds of Bond Issue including underwriters' discount)
22
-
23
Proceeds used for accrued interest ......................22
Issue price of entire issue (enter amount from line 21, column (b)) ............23 2,327,897
24 Proceeds used for bond issuance costs (including underwriters' discount) . 24 29,656
25 Proceeds used for credit enhancement .............25 1,366
26 Proceeds allocated to reasonably required reserve or replacement fund 26
27 Proceeds used to currently refund prior issues ..........27
28 Proceeds used to advance refund prior issues ..........28 2,296,464
29 Total (add lines 24 through 28) ........................29 2,327,486
30 Nonrefunding proceeds of the issue (subtract line 29 from line 23 and enter amount here) . . . 30 411
rTTl_Description of Refunded Bonds. Complete this part only for refunding bonds.
31 Enter the remaining weighted average maturity of the bonds to be currently refunded . . years
32 Enter the remaining weighted average maturity of the bonds to be advance refunded . 6.7221 years
33 Enter the last date on which the refunded bonds will be called (MM/DDIYYYY) 09/01/2017
34 Enter the date(s) the refunded bonds were issued - (MM/DD/YYYY) 07/10/2007
For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 63773S Form 8038-G (Rev. 9-2011)
If Amended Return, check here
21
Form 8038-G (Rev, 9-2011) Page 2
Miscellaneous
35 Enter the amount of the state volume cap allocated to the issue under section 141 (b)(5) . . 35
36a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract
(GIC) (see instructions) ..........................36a
b Enter the final maturity date of the GIC "
c Enter the name of the GIC provider 10
37 Pooled financings: Enter the amount of the proceeds of this issue that are to be used to make loans
to other governmental units .........................37
38a If this issue is a loan made from the proceeds of another tax-exempt issue, check box and enter the following information:
b Enter the date of the master pool obligation s" November 3,2016
C Enter the EJN of the issuer of the master pool obligation - 92-6001185
d Enter the name of the issuer of the master pool obligation - Alaska Municipal Bond Bank
39 If the issuer has designated the issue under section 265(b)(3)(13)(1)(111) (small issuer exception), check box . . . -
40 If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check box . ............ 111~ El
41a If the issuer has identified a hedge, check here Li and enter the following information:
b Name of hedge provider -
C Type of hedge -
d Term of hedge
42 If the issuer has superintegrated the hedge, check box ......................Li
43 If the issuer has established written procedures to ensure that all nonquafified bonds of this issue are remediated
according to the requirements under the Code and Regulations (see instructions), check box .........Li
44 If the Issuer has established written procedures to monitor the requirements of section 148, check box ......Li
45a If some portion of the proceeds was used to reimburse expenditures, check here Li and enter the amount
of reimbursement ..,......
b Enter the date the official intent was adopted '- -- - -- - -
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge
Signature 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
and process to the person authorized above.
Consent November 3, 2016
, Hansel L. Mathiaw, Finance Director
Signature of issuer's authorized representative Date r Type or print name and title
Print/Type preparer's name P per's sl9nattr/
P0
Paid
1467958
jt~at e vember 3, 2011 Check if PTIN
Preparer Cynthia L. Cartledge self-employed
Use Only Firm's name ' Jermain Dunnagan W'ens,P.C. I Firm's FIN - 92-0116216
Firm's address - 3000 A Street, Suite 300, Anchorage, Alaska 99503 1 Phone no, (907) 563-8844
Form 8038-G (Rev. 9-2011)
j A,,,'
3000 A Street, Suite 300 Anchorage, Alaska 99503
JERMAIN DUN NAGAN & OWENS, P.C. tel 907.563,8844 fax 907.563.7322 . www.jdolaw.com
November 7, 2016
7J '.L jUfJt ]1 1 JlJ:
Internal Revenue Service Center
Ogden, Utah 84201
Re: City of Bethel, Lease Revenue Refunding Bond, 2016; Our File No.
009495.00033
Ladies and Gentlemen:
Enclosed please find Form 8038-G in the above-referenced matter for filing.
Sincerely,
JERMAIN, DUNNAGAN & OWENS, P.C.
&
Shirley Rich, Legal Assistant
Enclosure as stated
(OO6597O)
® 722C
2. Article Number
11I I 11 filtH ililU 1111111 i 1
7196 9008 9111 0038 9646
I 3. Service Type CERTIFIEI) MAILOM
L 4, Restricted Delivery? (Extra Fee) LIJ Yes
1, Article Addressed to:
Internal Revenue Service Center
Ogden, UT 84201
72,
A. Received by (Please Print Clearly) S. Date of Delivery
C Signature
VED )\ EAont
i
D.
Addresses x
14P doli ve Is 1; 1 NO
-- 1
Reference Informati o n
009495.00033
CLC: snr
PS Form 3811, January 2005 Domestic Return Receipt