Tab_209i vue or Issue enter the issue once). See the instructions and attach schedule,
lucation
ealth and hospital ...............................12
ansportation ..............................13
ublic safety ,.,,.....,,,,,,,.,.,,..,,,.,
ivironment (including sewage bonds) .........................15
ousing ...........,,,,,.. 11 ,,...,,,.,
tilities ..........,,,,,,,,,.,, ........
Describe .ther.
11 4,736,530
-
-
14
16
17
obligations are TANs or RANs, check only box 19a .....,.,... - 0
obligations are BANS, check only box 19b .............. . .
obligations are in the form of a lease or installment sale, check box ,,,,... 0
Description of Obligations, Complete for the entire issue for which this form is being filed
(a) Final maturity date (b) issue price (c) Stated redemption
at maturity
(0) Weighted
price average maturity (e) Yield
12/01/2020 4,736,530 $ 4,470,000 26167 yearl 25985 %
11 E
12 1-
13 T
14 F
15 6
16 I-
17 L
16 C
19 If
If
20 If
21
Form Information Return for Tax-Exempt Governmental Obligations
(Rev, September 2011) Under internal Revenue Code section 149(e) OMB No. 1545-0720
11, Department of the Treasury See separate instructions.
Interns' °nvenue Service Caution: If the issue price is under$100,000, use Form 8038-GC,
ReDortincI Authority If Amended Return check here r
1 issuers name -- 2 issuers employer identification number (FIN)
Northwest Arctic Borough, Alaska - 92-0116661
35 Name of person (other than issuer) with whom the IRS may communicate about this return (see instructions) Sb Telephone number of other parson shown on 3a
4 Number and street (or P.O. box If mat is not delivered to street address) Room/suite 5 Report number (For IRS Use Only)
P.O. Box 1110
-
6 City, town, or post office, state, and ZIP code 7 Date of issue
Kotzebue, Alaska 99572 November 3, 2016
B Name of issue 9 CUSiP number
General ObligOtiol, Refunding Bond, 2016 Series A
-
None
lOs Name and title of officer or other employee of the issuer whom the IRS may cxii for more information (see lob Telephone number of officer or other
instructions) employee shown on lOa
Angeline Sturm, Finance Director 907.442.2500 ext. 152
-
iH Uses of Proceeds of Bond Issue (including underwriters' discoUnt)
22 Proceeds used for accrued interest .....................-
-
0
23 4,736,530
-
23 Issue price of entire issue (enter amount-from line 21, column (b)) . .............
24 Proceeds used for bond issuance costs (including underwriters' discount) , 24
-
33,663
26 Proceeds allocated to reasonably required reserve or replacement fund 26
25 Proceeds used for credit enhancement ..............25 3,052
27 Proceeds used to currently refund prior issues ..........27 4,695,729
28 Proceeds used to advance refund prior issues ...........28 0
29 Total (add lines 24 through 28) ..........................29 4,732,444
30 4066 30 Nonrefunding proceeds of the issue (subtract line 29 from line 23 and enter amount here) .
L 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 . . 2.5974 years
32 Enter the remaining weighted average maturity of the bonds to be advance refunded - , . . years
33 Enter the last date on which the refunded bonds will be called (MM/DDIYYYY) ..,,. 12105/2016
34 Enter the date(s) the refunded bonds were issued 111o. (MM/DDIYYYV) 01/31/2007 -
For Paperwork Reduction Act Notice, see separate instructions Cat No 63773S Form 8038-G (Rev. 9-2011)
Form 8038-C (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 0
36a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract
(GIC) (see instructions) .............................36a 0
-
b Enter the final maturity date of the GIC
C Enter the name of the GIC provider li -
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 j 0
38a If this issue is a loan made from the proceeds of another tax-exempt issue, check box 1 and enter the following information:
b Enter the date of the master pool obligation Do- 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)(6)(1)(111) (small issuer exception), check box . . .
40 If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check box ..............Lv'-
41a If the issuer has identified a hedge, check here lo. 0 and enter the following Information:
b Name of hedge provider
C Type of hedge
d Term of hedge 1>-
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 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 It some portion of the proceeds was used to reimburse expenditures, check here LI and enter the amount
of reimbursement .......... 111~-
b Enter the date the official intent was adopted 1>
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the beat 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 this return, to the person that I have authorized above.
Consent . I fj./o/, Angeline Sturm, Finance Director
authorized representative
Pate k ' or prtnt.namo and title
Paid Print/Type preparer's name Date Check fl If PTIN
Preparer Thomas Kltnkner U self-employed P01874546
Use Only Firm's name D. Birch Horton Biuner & Cherot I Firms EIN 920046806
Firms address t 1127 West 7th Avenue, Anc-horulg,. AK 99501 1 Phone no 907 263 7219
Form 8038-G (Rev. 9-2011)
Birch Horton Bittner & Cherot
a professional corporation Thomas F. Klinkner
Respond to Anchorage Office
T 907.263.7219 o F 907.276.3680
tklinkner@bhb.com
iiiGTZIl;siE
CERTIFIED M!1
p ii tuiiu
Department of the Treasury
Internal Revenue Service Center
Ogden, UT 84201-0074
RE: Northwest Arctic Borough, Alaska
Our File No.: 505,729.12
To Whom It May Concern:
ISSUE DATE DESCRIPTION
11/3/2016 Form 8083-G —GO Refunding Bonds, 2016 Series A
File original [ ] Prepaid return envelope enclosed
For your information/files [ ] For signature/notarize
3 Per your request [1 For filing
3 For review and comment [ I Return to our office
3 Returned to you [3 Forward to:
Please call Tom Klinkner at (907) 276-1550, if you have any questions.
Yours truly,
jho_~,~ 'J t~~
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
I 907.2761550 800.478,1550. F 907276.3680 T202.659.5800 F 202.659.1027
505729\12\00558122
LAW OFFICES
BIRCH HORTON BITTNER & CHEROT
A PROFESSIONAL CORPORATION
1127 WEST SEVENTH AVENUE
ANCHORAGE, ALASKA 99501
505,729.12 I I It I .1
91 7108 2133 3937 2497 3877
ItTPifl IflT - -
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