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Tab_176(Rev, September 2011) Department of the Treasury Interns' P'venue Service ReDorti Information Return for Tax-Exempt Governmental Obligations f'- Under Internal Revenue Code section 14.9(e) OMB No. 1545-0720 See separate instructions. Caution: If the issue price is under $WO,000, use Form 8038-GC. If Amnded Return cheek here Do- I Issuers name 2 Issuer's employer Identification number (EIN) City of Kodiak, Alaska 92.6000083 3a Name of parson (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) Room/suite 5 Report number (For IRS Use Only) .1710 Mill gay Road 131 6 City, town, or post office, state, and ZIP code 7 Date of issue Kodiak, Alaska 99615 November 3, 2016 B Name of issue 9 CUSIP number General ObIi(ation ReIurtding Bond, 2016 Series A None lOs 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 Oa Kelly Mayes, Finance Director 907.486.8659 1jjtype Of tssue (enter the issue price). See the instructions and attach schedule. 11 12 13 14 15 16 17 18 19 20 Education Health and hospital .......,,,,.,,,,,,,,,.,., Transportation .....................................13 Public safety ................................14 Environment (including sewage bonds) .......................16 Housing ..................................16 Utilities ...................................17 Other, Describe If obligations are TANS or RANs, check only box 19a ..................Do.0. If obligations are BANS, check only box 19b ..................0 If obligations are in the form of a lease or installment sale, check box ........ 0 = 11 ia - 18 744,398 Obligations. Complete Description of entire issue for which this form is being filed. (a) Final maturity date (b) Issue price (r) Stated redemption (d) Weighted 1 (o) Yield price at maturity average maturity 121 I 1210112037 6,744,398j $ 6,355,000 12.5233 years 2.5985 % Uses of Proceeds of Bond Issue (Including underwriters' discount) . 22 Proceeds used for accrued interest ...........................22 0 - 23 6,744,398 24 Proceeds used for bond issuance costs (including underwriters' discount). 24 $8.088j 26 Issue price of entire issue (enter amount from line 21, column (b)) ...................23 26 Proceeds allocated to reasonably required reserve or replacement fund 26 27 Proceeds used for credit enhancement .............25 4339 Proceeds used to currently refund prior issues ..........27 28 Proceeds used to advance refund prior issues ..........28 6,682,661 29 6,743,088 30 Total (add lines 24 through 28) ..........................29 hionrefundlng proceeds of the issue (subtract line 29 from line 23 and enter amount here) . . 30 1,310 I Description of Refunded Bonds. Complete this part only for refunding bonds 31 Enter the remaining weighted average maturity of the bonds to be currently refunded years 32 Enter the remaining weighted average maturity of the bonds to be advance refunded . •. jZyars 33 Enter the last date on which the refunded bonds will be called (MM/DD/YYYY) 04/01/2018 34 Enter the date(s) the refunded bonds were issued Do, (MM/DDfYYYY 04/15/2008 For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 63773$ Form 8038-G (Rev. 9-2011) 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) . 351 0 36a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract (GIC) (see instructions) ........................ 36a I 0 - b Enter the final maturity date of the GIG - c Enter the name of the GIG provider 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 0 38a If this issue is a loan made from the proceeds of another tax-exempt issue, check box IZI and enter the following information: b Enter the date of the master pool obligation November 3, 2016 C Enter the EIN 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)(1I1) (small issuer exception), check box Li 40 If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check box .................Li 41a If the issuer has identified a hedge, check here Do Li and enter the following information: b Name of hedge provider C Type of hedge 0> d Term ofhedge 42 If the issuer has superintegrated the hedge, check box ..................... Li 43 If the issuer has established written procedures to ensure that all nonqualified bonds of this issue are remodiated 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 Ib& Aum,.to tpe person that I have authorized above. Consent Kelly Mayes, Finance Director Slonalturo of Is r'e mithe 0 representative ate I ypa or print name and title Print/Type preparer's name Jn4 ,cig (ure1J 71 Date PTIN Paid ii Check Li if Preparer Thomas Klinkrter . self-employed P01874546 Use Only Firm's name t.. Birch Horton Bittner & Cherot Firm's EIN P1 920046806 Flrrn'saddrCss - 1127 West 7th Avenue, Anchorage AK 99501 Phoien, 907.263.7219 Form 8038G (Rev. 9-2011) Birch Horton Bittner & Cherot a pWJIZsiOfla1co?poration Thomas F. Klinkner Respond to Anchorage Office T 907.263.7219 a F 907.276.3680 tklinkner@bhb.com November 8, 2016 ; I IJ'L! FI.I I! Department of the Treasury Internal Revenue Service Center Ogden, UT 84201-0074 RE: City of Kodiak, Alaska Our File No.: 505,780.158 To Whom It May Concern: ISSUE DATE DESCRIPTION 11/3/2016 Form 8038-G —GO Refunding Bonds, 2016 Series A File original I ] Prepaid return envelope enclosed 3 For your information/files [ 3 For signature/notarize [3 Per your request [ 3 For filing ] For review and comment [ 3 Return to our office [1 Returned to you [ ] Forward to: Please call Tom Klinkner at (907) 276-1550, if you have any questions. Yours truly, 11110 J'641t~ j - tUt Thomas F. Klinkner TFK: lcj Enclosure 1127 West Seventh Ave., Anchorage, AK 99501-3301 1156 15th St. NW., Ste. 1020, Washington, D.C. 20005-1754 T 907,276.1550 ' 800,478.1550 - F 907.276.3680 1 T 202.659.5800 ' F 202.659.1027 505786\83\00558118 L 91 7108 2133 3937 2497 3853 BIRCH HORTON BITTNER & CHEROT 1127 WEST SEVENTH AVENUE ANCHORAGE AK 99501 IIMmmmM IIIRIMIRMIM 505,786.83 DEPARTMENT OF THE TREASURY IbIiIw REVENUE SERVICE CENTER t•1 Internal Revenue Service Ogden UT 84201-0074 03473.566651.175872.3085 1 AV 0.376 373 III 111111111011611111 [111111111611 111 fig 1121181111188 1121 Jill 1111 Notice CPI52 Tax period November 30, 2016 Notice date December 19, 2016 Employer ID number 92-6000083 To contact us Phone 1-877-829-5500 FAX 801-620-5555 % FINANCE DIRECTOR PO BOX 1397 KODIAK AK 99615-1397 Acknowledgment of your November 3, 2016 Form 8038-G We r e ceived your tax-exe ff111 i1iiiIJ{S]iiT This notice serves as that we received your Form 8038-G. If you filed more than one form, you will receive a separate Name o, ii ;ve GENERAL OBLIGATION REFUND14G BOND 2____ acknowledgment for each one. Lwiir numuer NONE . u .November 3, 20 16 ME Important reminders - Attach a copy of this notice to all of your cor espondence and documents related t thisNtax-exe i h 1 a It a tax practitioner or someone else prepared your form, you may want to give the a copy of this notice. (A copy was automatically sent to all iepresentatives authorized with a Power-of-Attorney for this form,) I Additional informati on Visitwww.irs.gov/cp152. For tax forms, instructions, and publications, visit www.irs.gov or call 1-800-TAX-FORM (1-800-829-3676). If you have questions about tax-exempt bonds, call TEGE Customer Account Services at 1-877-829-5500. Keep this notice for your records, If you need assistance, please don't hesitate to contact us