Tab_251Form 8038G I Information Return for Tax-Exempt Governmental Obligations I
(Rev. September 2011) - Under Internal Revenue Code section 149(e) 01VIB No. 1545-0720
Department of the Treasury - See separate instructions. I I
Internal Revenue Service Caution; If the issue price is under $100,000, use Form 8038-GC. I
Renortina Authority If Amended Return, cheek here '- I
1 Issuers name S 2 Issuers employer Identification number (E1N(
Municipality of Skagway, Alaska 92-6000088
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.0, box If mail is not delivered to street address) Room/suite 5 Report number (For IRS Use Only)
P,0. Box 415
S City, town, or post office, state, and ZIP code 7 Date of Issue
Skagway, Alaska 99840 11/03/2016
8 Name of Issue 9 CUSIP number
General Obligation Refunding Bond, 2016 None
105 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 ba
Heather Rodig, Treasurer 907-983-2297
11iIlI Type of Issue (enter the issue price). See the instructions and attach schedule
11
12 Health and hospital ...........................12
13
Education ...............................11
Transportation ................................13
14
15
16
Public safety ..............................14
17
environment (including sewage bonds) ......................15
Housing ...............................16
18
Utilities ................................17
Other, Describe Refund construction of Community Health Center 18 3,339,555
19 If obligations are TANs or RANs check only box iSa El
If obligations are BANs check only box 19b ' El
20 If obligations are in the form of a lease or installment sale check box - El I
Description of Obligations. Complete for the entire issue for which this form is being filed.
(a) Final maturity date (b) Issue price (o) Stated redmr on price at matury average maturity (e) Yield
21 12/01/2027 I 3,339,555 1 $ 2,875,0001 7.0033 years 2.5985 %
I1LA Uses of Proceeds of Bond Issue (including underwriters' discount)
22 Proceeds used for accrued interest .....................22 0
23 Issue price of entire issue (enter amount from line 21, column (b)) ...........L23 3339,555
-
24 Proceeds used for bond Issuance costs (including underwriters' discount). 24 23,097
25 0
26 Proceeds allocated to reasonably required reserve or replacement fund 26 0
27
Proceeds used for credit enhancehient .............25
0
28
Proceeds used to currently refund prior issues ..........27
Proceeds used to advance refund prior issues ..........28 3,316,210
-
29 3,339,307
30
Total (add lines 24 through 28) .........................29
Nonrefunding proceeds of the issue (subtract line 29 from line 23 and enter amount here) . 30 248
-
I1Th!1 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 . . N/A , years
32 Enter the remaining weighted average maturity of the bonds to be advance refunded . . . - 7.4569 years
33 Enter the last dote on which the refunded bonds will be called (MM/DD/YYYY) ......- 06/01/2018
34 Enter the date(s) the refunded bonds were Issued - (MMIDDA'YY'ff 07/30/2008
For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 637735 Form 8038 -G )Rev. 9-2011)
Form 8038-0 (Rev. 9-2011) Page 2
35 Enter the amount of the state volume cap allocated to the issue under section 141 (b)(5) 35 1 0
36a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract
0
b Enter the final maturity date of the GIC k-
C
(GIC) (see instructions) ..........................36a
Enter the name of the GIC 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 - and enter the following information:
b Enter the date of the master pool obligation L- 11/03/2016
C Enter the EN of the Issuer of the master pool obligation 926001185
ci 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)(B)(i)(111) (small issuer exception), check box . . . - 0
40 If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check box .............- 0
41a If the issuer has identified a hedge, check here - 0 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 ......................0
43 If the issuer has established written procedures to ensure that all nonqualified bonds of this Issue are remedlated
according to the requirements under the Code and Regulations (see instructions), check box ........ 0
44 If the issuer has established written procedures to monitor the requirements of section 148, check box .....- 0
45a If some portion of the proceeds was used to reimburse expenditures, check here k- 0 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 proces thI4 return to the pa that I hal ahodzed abo
Consent
Paid
~tgr aufflorized representative Datt Type or print name and title
Preparer 1 Robert Starin self-employed
Print/Type preparer's name Pai-W-5sigoat Date
ark El if
.her Rodig,
PTiNPol4658:4g
Use Only Firm's name - K&L Gates LLP Firm's EIN 2509210
Firm's address - 925 Fourth Avenue, Suite #2900, Seattle WA 9 8104-1158 Phone no,
Form 8038G (Rev. 9-2011)
K&L GATES LLP
925 FOURTH AVENUE
SUITE 2900,
SEATTLE, WA 98104-1158
T +1206 623 7580 F +1206 623 7022 klgatesconi
December 20, 2016
VIA CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Department of the Treasury
Internal Revenue Service Center
Ogden, UT 84201
Re: Municipality of Skagway, Alaska
General Obligation Refunding Bond, 2016 - $3,335,000
Ladies and Gentlemen;
Enclosed please find an IRS Form 8038-G relative to the above-captioned issue.
Please acknowledge receipt of the same by signing the enclosed, duplicate copy of this letter
where indicated, and returning it to me in the enclosed pre-addressed envelope.
Thank you for your assistance in this matter.
Very truly yours,
K&L GATES LLP
By
Kerry. Salas
Senior Paralegal
Enclosures
I hereby acknowledge receipt of IRS Form 8038-G as submitted by the Municipality of
Skagway, Alaska, regarding its General Obligation Refunding Bond, 2016.
Date:
500190955 vi
klgates.com
AFFIDAVIT OF MAILING
STATE OF WASHINGTON)
)ss,
COUNTY OF KING )
& Mo ~0,t6, being duly sworn, deposes and s at hs a
cit ZeR of the Unitd States and over the age of eighteen years; that a resident of
Ux'f
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Coiinty, Washington.
That on December ca), 2016, at L 3a.rn)&aused IRS Form 8038-G,
completed by the Municipality of Skagway, Alaska, 4respect to its General Obligation
Refunding Bond, 2016, to be mailed by depositing the same in the United States mail, in a sealed
envelope, certified delivery, first class, postage prepaid, properly addressed to the Department of
the Treasury, Internal Revenue Service Center, Ogden, Utah 84201.
7 003 I 692 000 3 J OD
I certify that I know or have satisfactory evidence that11QC )Y2(J f is
the person who appeared before me, and said person acknowledged tht 1éLs -griéd this
instrument, and acknowledged it to be hi(~ Qer ree and voluntary act for the uses and purposes
mentioned in the instrument.
Dated: c O
Notay' PuIic
PrirNanie
My commission expires
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Department of the Treasury
or P0 Box No, Internal Revenue Service Center
CftySite,2iP+- Ogden, UT 84201
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