Tab 27 IRS Form 8038-G..........
809M,
Fom I a8mu
(Rev. May 1999) '
DePartment of the Treasury
Internal Revenue Service
Information Return for Tax -Exempt Governmental Obligations
jo. Under Internal Revenue Code section 149(e)
0. See separate Instructions.
Caution: Use Form 8038-GC if the issue price is under $100,000.
OMB No. 1545-0720
11, RM M Reoortina Authorltv If Amended Return. check hp-rp- 6. 71
I Issuer's name
2 Issuer's employer Identification number
EALISPELL, CITY OF MONTANA
81-6001281
3 Number and street (or P 0. box if mail is not delivered to street address)
Room/suite
4 Report number
312 FIRST AVENUE EAST
G 2001- 1
5 City� town, or post office, state, and ZIP code
6 Date of issue
KALISPELL, MT 59903
JUNE-129 2001
7 Name of issue
8 CUSIP number
SPECIAL IMPROVEMENT DISTRICT NO. 343 BONDS
48342Q AVO
9 N a me a nd titl e of offi cer or I ega I representative whom the I RS m ay ca I I fo r m ore i nformati on
10 Telephone number of officer or lega( representative
AMYROBEIRTSON, FINANCE DIRECTOR
758-7701
6-u Type of Issue (check applicable box(es) and enter the issue price) See instructions and attach schedule
11 Education ................................................................ .
12 F-1 Health and hospital ................. . . . . . . . . . . . . . . d . . . . . . . . . . . . . . . . . . . . .
13 E] Transportation ........ I ............ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14 El Public safety ..................................... d ..........................
15 El Environment (including sewage bonds) ............................................
16 El Housing .............................................. d ....................
17 Ej Utilities ........................................... .......................
18 Other. Describe jo. street and gfility improvements
19 If obligations are TANs or RANs, check box po. If obligations are BANs, check box ......
20 If obligations are in the form of a lease or installment sale, check box .................
11
12
3
14
15
16
17
18
1,5813500
vl� le -7, N, - Z,
2", Ng V
------------------
-7, oi3j Description of Obligations. (Complete for the entire issue for which this form is being filed.)
ju
(a) Final maturity date
(b) Issue price
(c) Stated redemption
price at maturity
(d) Weighted
average maturity
(e) Yield
21
7/1/21
is
12581�500
1 10.645 years
5.05196 %
/-i'
Uses of Proceeds of Bond Issue (including underwriters' discount)
22 Proceeds used for accrued interest ..................................................
23 Issue price of entire issue (enter amount from line 21, column (b)) ..........................
24 Proceeds used for bond issuance costs (including underwriters' discount) 24 51.778.57 __,62I
25 Proceeds used for credit enhancement ........................... 25 0
26 Proceeds allocated to reasonably required reserve or replacement fund . . 26 0
27 Proceeds used to currently refund prior issues ..................... 27 0
28 Proceeds used to advance refund prior issues ..................... E2 8 0
29 Total (add lines 24 through 28) .......... .........................................
30 Nonrefunding proceeds of the issue (s -0 "Ct
_,v e 29 from line 23 and enter amount here) ........
22
2312.49
23
1,581,500.
,iM, Ri
V
A,
513778.57
29
30
1,529,721.43
Description of Re" n4gk�omplete this part only for refunding bonds.)
31 Enter the remaining i;Aaturh the bonds to be currently refunded ........... jo. years
r
32 Enter the remaini _vvelg average rn he bonds to be advance refunded ........... jo. years
33 Enter the last date n ich th ref nd be called ............................ jo.
34 Enter the date(s) th r nde d vvereJ8 ed 0.
111 P: A Miscellane&1\,
35 Enter the amount of thkst4ere 5-,ujtW ocated to the issue under section 141 (b)(5) ......... 35 0
36a Enter the amount of gross pro s i or to be invested in a guaranteed investment contract (see instructions) 36a 0
j f t
b Enter the final maturity d the guaranteed investment contract jo.
37 Pooled financings: a Proceeds of this issue that are to be used to make loans to other governmental units ........... 37a 0
b If this issue is a loan made from the proceeds of another tax-exempt issue, check box Do. 1:1 and enter the name of the
issuer oo, and the date of the issue po.
38 If the issuer has designated the issue under section 265(b)(3)(B)(i)(Ill) (small issuer exception), check box ............ 00-
39 If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check box .................................. No-
40 If the issuer has identified a hedge, check box .......................................................... jo-
uncler penalties of perjur)6 I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief,
Please they are t e. correct and pomplete. WELLLkM BOHARSKI
Sign
MAYOR
Here Signature of issuer's authorized representative IDate TvDe or r)rint name and title
For Paperwork Reduction Act Notice, see page 2 of the Instructions. ISA
STIF FED6403F
Form 8038-G(Rev. 5-99)
DORSEY & WHITNEY LLP
MINNEAPOLIS
NEW YORK
SEATTLE
DENVER
WASHINGTON, D.C.
DES MOINES
ANCHOR,AGE
LONDON
COSTA MESA
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Internal Revenue Service
Ogden, UT 84201
MILLENium BUILDING
BILLINGS
125 BANK STPLEET, SUITE 600
GFt.EAT FALLS
MISSOULA, MONTANA 59802
MISSOULA
TELEPHONE: (406) 721-6025
BRUSSELS
FAX: (406) 543-0863
FARGO
MAE NAN ELLINGSON
HONG KONG
effingson.rme.rianadorseylaw-com
ROCHESTER
SALT LAKE CITY
VANCOUVEP,
June 19, 2001
RE: $115 8 1 � 5 00 Sp ecial Improvement District No . 3 43 B onds
City of Kalispell, Montana
Dear Sir/Madam:
Enclosed are two 8038-G's, Information Return for Tax -Exempt Governmental
Obligations, filed pursuant to Section 149(e) of the Internal Revenue Code with respect to the
issuance of the Issuer's bonds.
Please file one copy of the enclosed Form 8038-G and acknowledge receipt by
signing and dating the enclosed duplicate thereof and returning to the undersigned.
Very truly yours,
Mae Nan Ellingson
MNE/ kh
j
Enclosure