This form contains 137 fields organized into 20 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Bond Details
11j j Qualified empowerment zone facility bonds (section 1394(f)) (see instructions) Text
Enter the amount for Qualified empowerment zone facility bonds as per section 1394(f). Refer to the instructions for more details.
11k k Qualified broadband projects (sections 142(a)(16) and 142(n)) Text
Enter the amount for Qualified broadband projects as per sections 142(a)(16) and 142(n). Refer to the instructions for more details.
11 I Qualified public educational facility bonds (sections 142(a)(13) and 142(k)) Text
Enter the amount for Qualified public educational facility bonds as per sections 142(a)(13) and 142(k). Refer to the instructions for more details.
Qualified highway or surface freight transfer facilities (sections 142(a)(15) and 142(m)). n 11n Text
Enter the amount for Qualified highway or surface freight transfer facilities as per sections 142(a)(15) and 142(m). Refer to the instructions for more details.
Qualified carbon dioxide capture facilities (sections 142(a)(17) and 142(o)) O 110 Text
Enter the amount for Qualified carbon dioxide capture facilities as per sections 142(a)(17) and 142(o). Refer to the instructions for more details.
q Other (see instructions) a3e1 11g Text
Enter the amount for other qualified bonds as specified in the instructions. Refer to the instructions for more details.
12a Qualified mortgage bond (section 143(a)) 12a Text
Enter the amount for Qualified mortgage bond as per section 143(a). Refer to the instructions for more details.
b 12b Text
Enter the amount for the specified bond type. Refer to the instructions for more details.
topmostSubform[0].Page1[0].f1_39[0 Text
Enter the details for the bond issue. This field is likely for additional information or specific details about the bond.
16 Text
Enter the relevant information for item 16 as specified in the form instructions.
topmostSubform[0].Page1[0].f1_41[0 Text
Enter the relevant information for item 17 as specified in the form instructions.
18 Text
Enter the relevant information for item 18 as specified in the form instructions.
topmostSubform[0].Page1[0].f1_45[0 Text
Enter the relevant information for item 20b as specified in the form instructions.
topmostSubform[0].Page1[0].f1_46[0 Text
Enter the relevant information for item 20c as specified in the form instructions.
18dc 20c Text
Enter the relevant information for item 20c as specified in the form instructions.
Enter the remaining weighted average maturity of the tax-exempt bonds to be refunded. 33 Text
Enter the remaining weighted average maturity of the tax-exempt bonds to be refunded. This is required for Line 33.
35 Enter the last date on which the refunded tax-exempt bonds will be called (MM/DD/YYYY) Text
Enter the last date on which the refunded tax-exempt bonds will be called in MM/DD/YYYY format. This is required for Line 35.
Max length: 2 characters
36 Enter the date(s) the refunded bonds were issued (MM/DD/YYYY) Text
Enter the date(s) the refunded bonds were issued in MM/DD/YYYY format. This is required for Line 36.
Max length: 2 characters
Bond Issue Details
7 Date of issue (MM/DD/YYYY) Text
Enter the date of issue in MM/DD/YYYY format.
Max length: 10 characters
8 Name of issue Text
Enter the name of the bond issue.
9 CUSIP number Text
Enter the CUSIP number of the bond issue.
11c Text
Enter the specific details related to the bond issue as required in section 11c.
11c c58e 11d Text
Provide additional information related to sections 11c and 11d of the bond issue.
e 11e Solid waste disposal facilities (section 142(a)(6)) Text
Specify details about solid waste disposal facilities as per section 142(a)(6).
11f f Qualified residential rental projects (sections 142(a)(7) and 142(d)) (see instructions) Text
Enter information about qualified residential rental projects according to sections 142(a)(7) and 142(d). Refer to the instructions for more details.
topmostSubform[0].Page1[0].c1_2[0]_1 CheckBox
Check this box if applicable to the bond issue.
topmostSubform[0].Page1[0].c1_2[1]_2 CheckBox
Check this box if applicable to the bond issue.
topmostSubform[0].Page1[0].c1_2[2]_3 CheckBox
Check this box if applicable to the bond issue.
topmostSubform[0].Page1[0].c1_3[0]_1 CheckBox
Check this box if applicable to the bond issue.
topmostSubform[0].Page1[0].c1_3[1]_2 CheckBox
Check this box if applicable to the bond issue.
11g Text
Enter the specific details related to the bond issue as required in section 11g.
11h h Facilities allowed under a transitional rule of the Tax Reform Act of 1986 (see instructions) Text
Provide information about facilities allowed under a transitional rule of the Tax Reform Act of 1986. Refer to the instructions for more details.
topmostSubform[0].Page1[0].Line11h_ReadOrder[0].f1_21[0 Text
Enter the specific details related to the bond issue as required in section 11h.
1986 Act section Text
Specify the section of the 1986 Act that applies to the bond issue.
topmostSubform[0].Page1[0].f1_23[0 Text
Enter any additional information required for the bond issue.
topmostSubform[0].Page2[0].Table_Part3[0].Line21[0].f2_01[0 Text
Enter the relevant information for Line 21, Part 3, Table on Page 2.
Text
Enter the relevant information for Line 21, Part 3, Table on Page 2.
Text
Enter the relevant information for Line 21, Part 3, Table on Page 2.
topmostSubform[0].Page2[0].Table_Part3[0].Line21[0].f2_04[0 Text
Enter the relevant information for Line 21, Part 3, Table on Page 2.
(e) Yield Text
Enter the yield for the bond issue in Line 21(e), Part 3, Table on Page 2.
22 Text
Enter the relevant information for Line 22 on Page 2.
23 Text
Enter the relevant information for Line 23 on Page 2.
b Name of empowerment zone Text
Enter the name of the empowerment zone associated with the bond issue.
Bond Issue Purpose
11a a Airport (sections 142(a)(1) and 142(c)) Text
Indicate if the bond issue is for an airport as per sections 142(a)(1) and 142(c).
11b b Docks and wharves (sections 142(a)(2) and 142(c)) Text
Indicate if the bond issue is for docks and wharves as per sections 142(a)(2) and 142(c).
Bond Type
topmostSubform[0].Page1[0].c1_4[0]_1 CheckBox
Check this box if the bond issue is a qualified small issue bond under section 144(a). Refer to the instructions for more details.
14 Qualified small issue bond (section 144(a)) (see instructions) 14 Text
Enter the details for a qualified small issue bond under section 144(a). Refer to the instructions for more details.
topmostSubform[0].Page1[0].c1_5[0]_1 CheckBox
Check this box if the bond issue is a nongovernmental output property bond treated as a private activity bond under section 141(d).
topmostSubform[0].Page1[0].c1_6[0]_1 CheckBox
Check this box if the bond issue falls under another category specified in the instructions.
19 Nongovernmental output property bond (treated as private activity bond) (section 141(d)) 19 Text
Enter the details for a nongovernmental output property bond treated as a private activity bond under section 141(d).
20a Other (see instructions) Text
Enter details for any other bond type not specifically listed. Refer to the instructions for more details.
C Other. Describe (see instructions) Text
Describe any other bond type or relevant information as specified in the instructions.
Carryforward Election
b Under a carryforward election. Attach a copy of Form 8328 to this return 49b Text
Enter the amount under a carryforward election. Attach a copy of Form 8328 to this return.
Certification
certification . 51a Text
Provide the certification details as required in section 51a.
Type or print name and title Text
Type or print the name and title of the person completing this section.
topmostSubform[0].Page3[0].c3_1[0]_1 CheckBox
Check this box if applicable.
Checkboxes
topmostSubform[0].Page2[0].c2_1[0]_1 CheckBox
Check this box if applicable. Refer to the form instructions for specific details.
topmostSubform[0].Page2[0].c2_2[0]_1 CheckBox
Check this box if applicable. Refer to the form instructions for specific details.
topmostSubform[0].Page2[0].c2_3[0]_1 CheckBox
Check this box if applicable. Refer to the form instructions for specific details.
Contact Information
topmostSubform[0].Page1[0].f1_03[0 Text
Enter the name of the person to contact for more information.
3b Telephone number of other person shown on 3a Text
Enter the telephone number of the person listed in field 3a.
10a Name and title of officer or other employee of the issuer whom the IRS may call for more information Text
Enter the name and title of the officer or other employee of the issuer whom the IRS may call for more information.
10b Telephone number of officer or other employee shown on 10a Text
Enter the telephone number of the officer or other employee listed in field 10a.
Current Refunding Exception
d Under the exception for current refunding (section 146(i) and section 1313(a) of the Tax Reform Act of 1986) 49d Text
Enter the amount under the exception for current refunding (section 146(i) and section 1313(a) of the Tax Reform Act of 1986).
Financial Details
topmostSubform[0].Page2[0].Table_Lines32a-b[0].Line32a[0].f2_21[0 Text
Enter the amount for line 32a as specified in the instructions.
topmostSubform[0].Page2[0].Table_Lines32a-b[0].Line32a[0].f2_22[0 Text
Enter the amount for line 32a as specified in the instructions.
topmostSubform[0].Page2[0].Table_Lines32a-b[0].Line32b[0].f2_23[0 Text
Enter the amount for line 32b as specified in the instructions.
topmostSubform[0].Page2[0].Table_Lines32a-b[0].Line32b[0].f2_24[0 Text
Enter the amount for line 32b as specified in the instructions.
topmostSubform[0].Page2[0].Table_Lines32c-d[0].Line32c[0].f2_25[0 Text
Enter the amount for line 32c as specified in the instructions.
topmostSubform[0].Page2[0].Table_Lines32c-d[0].Line32c[0].f2_26[0 Text
Enter the amount for line 32c as specified in the instructions.
topmostSubform[0].Page2[0].Table_Lines32c-d[0].Line32d[0].f2_27[0 Text
Enter the amount for line 32d as specified in the instructions.
topmostSubform[0].Page2[0].Table_Lines32c-d[0].Line32d[0].f2_28[0 Text
Provide the information required for Line 32d. Refer to the form instructions for specific details.
34 Text
Provide the information required for Line 34. Refer to the form instructions for specific details.
topmostSubform[0].Page2[0].f2_32[0 Text
Provide the information required for this field. Refer to the form instructions for specific details.
Max length: 2 characters
topmostSubform[0].Page2[0].f2_33[0 Text
Provide the information required for this field. Refer to the form instructions for specific details.
Max length: 4 characters
ff Text
Provide the information required for this field. Refer to the form instructions for specific details.
Max length: 2 characters
ff / 71 Text
Provide the information required for this field. Refer to the form instructions for specific details.
Max length: 4 characters
d Term of hedge Text
Enter the term of the hedge associated with the bond issue.
42a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract (GIC) Text
Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract (GIC).
Enter the name of the GIC provider ▶C Text
Enter the name of the GIC provider.
Enter the amount of gross proceeds invested or to Text
Enter the amount of gross proceeds invested or to be invested. Note that the maximum length is 2 characters.
Max length: 2 characters
Amount of section 142(k)(5) volume cap allocated to issuer. Attach copy of state certification 52 Text
Specify the amount of section 142(k)(5) volume cap allocated to the issuer. Attach a copy of the state certification.
General Information
topmostSubform[0].Page1[0].c1_1[0]_1 CheckBox
Check this box if applicable.
topmostSubform[0].Page2[0].f2_18[0 Text
Enter the relevant information for the specified field.
topmostSubform[0].Page2[0].f2_20[0 Text
Enter the relevant information for the specified field.
topmostSubform[0].Page2[0].f2_39[0 Text
Please provide the relevant information for this field as required by the form.
topmostSubform[0].Page2[0].f2_40[0 Text
Please provide the relevant information for this field as required by the form.
topmostSubform[0].Page2[0].c2_4[0]_1 CheckBox
Check this box if applicable to your bond issue.
topmostSubform[0].Page2[0].f2_43[0 Text
Provide the relevant information for this field. Note that the maximum length is 2 characters.
Max length: 2 characters
topmostSubform[0].Page2[0].f2_44[0 Text
Provide the relevant information for this field. Note that the maximum length is 2 characters.
Max length: 2 characters
topmostSubform[0].Page2[0].f2_45[0 Text
Provide the relevant information for this field. Note that the maximum length is 4 characters.
Max length: 4 characters
topmostSubform[0].Page2[0].c2_5[0]_1 CheckBox
Check this box if applicable to your bond issue.
topmostSubform[0].Page2[0].c2_6[0]_1 CheckBox
Check this box if applicable to your bond issue.
45a Text
Please provide the relevant information for this field as required by the form.
topmostSubform[0].Page2[0].f2_49[0 Text
Provide the relevant information for this field. Note that the maximum length is 2 characters.
Max length: 2 characters
topmostSubform[0].Page2[0].f2_50[0 Text
Enter the relevant information for field f2_50 on Page 2. This field has a maximum length of 4 characters.
Max length: 4 characters
topmostSubform[0].Page2[0].c2_7[0]_1 CheckBox
Check this box if applicable for field c2_7 on Page 2.
topmostSubform[0].Page2[0].f2_51[0 Text
Enter the relevant information for field f2_51 on Page 2.
topmostSubform[0].Page2[0].f2_52[0 Text
Enter the relevant information for field f2_52 on Page 2. This field has a maximum length of 10 characters.
Max length: 10 characters
topmostSubform[0].Page3[0].f3_03[0 Text
Enter the relevant information for field f3_03 on Page 3.
topmostSubform[0].Page3[0].f3_04[0 Text
Enter the relevant information for field f3_04 on Page 3.
topmostSubform[0].Page3[0].f3_06[0 Text
Enter the relevant information for field f3_06 on Page 3.
Issuer Details
37 Name of governmental unit(s) approving issue (see the instructions) Text
Enter the name of the governmental unit(s) that approved the issue. Refer to the instructions for Line 37.
a7f5 Text
Provide the information required for this field. Refer to the form instructions for specific details.
Issuer Information
1 Issuer's name Text
Enter the full legal name of the issuer.
2 Issuer's employer identification number Text
Enter the issuer's employer identification number (EIN). This should be a 9-digit number.
Max length: 10 characters
topmostSubform[0].Page1[0].f1_05[0 Text
Enter the street address of the issuer.
Room/suite Text
Enter the room or suite number of the issuer's address.
6 City, town, or post office, state, and ZIP code Text
Enter the city, town, or post office, state, and ZIP code of the issuer's address.
Preparer Information
Print/Type preparer's name Text
Print or type the name of the preparer of this form.
Preparer's PTIN Text
Enter the Preparer's PTIN (Preparer Tax Identification Number). Maximum length is 11 characters.
Max length: 11 characters
Firm's name Text
Enter the name of the preparer's firm.
Firm's address Text
Enter the address of the preparer's firm.
Firm's EIN Text
Enter the Employer Identification Number (EIN) of the preparer's firm. Maximum length is 10 characters.
Max length: 10 characters
Phone no Text
Enter the phone number of the preparer's firm.
Proceeds Usage
24 Proceeds used for bond issuance costs (including underwriters' discount) 24 Text
Enter the amount of proceeds used for bond issuance costs, including underwriters' discount, in Line 24 on Page 2.
topmostSubform[0].Page2[0].f2_09[0 Text
Enter the relevant information for Line 25 on Page 2.
26 Proceeds allocated to reasonably required reserve or replacement fund 26 Text
Enter the amount of proceeds allocated to a reasonably required reserve or replacement fund in Line 26 on Page 2.
topmostSubform[0].Page2[0].f2_11[0 Text
Enter the relevant information for Line 27 on Page 2.
28 Proceeds used to refund prior taxable bonds. Complete Parts V and VI 28 Text
Enter the amount of proceeds used to refund prior taxable bonds in Line 28 on Page 2. Complete Parts V and VI.
29 Text
Enter the relevant information for Line 29 on Page 2.
30 Nonrefunding proceeds (subtract line 29 from line 23, enter amount here, and complete Part V) 30 Text
Enter the amount of nonrefunding proceeds by subtracting Line 29 from Line 23 and enter the amount here in Line 30 on Page 2. Complete Part V.
a Text
Enter the relevant information for Line 30(a) on Page 2.
State Volume Cap
47 47 Amount of state volume cap allocated to the issuer. Attach copy of state certification Text
Enter the amount of state volume cap allocated to the issuer. Attach a copy of the state certification.
48 48 Amount of issue subject to the unified state volume cap Text
Enter the amount of the issue subject to the unified state volume cap.
Transitional Rules
Under transitional rules of the Tax Reform Act of 1986. Enter Act section 92c8 C 49c Text
Enter the section of the Tax Reform Act of 1986 under transitional rules. Enter Act section.
Unlabeled Fields
topmostSubform[0].Page1[0].f1_27[0 Text
This field appears to be missing a label. Please refer to the form instructions or context for the correct information to enter here.
topmostSubform[0].Page1[0].f1_30[0 Text
This field appears to be missing a label. Please refer to the form instructions or context for the correct information to enter here.
topmostSubform[0].Page1[0].f1_31[0 Text
This field appears to be missing a label. Please refer to the form instructions or context for the correct information to enter here.
topmostSubform[0].Page1[0].f1_32[0 Text
This field appears to be missing a label. Please refer to the form instructions or context for the correct information to enter here.
topmostSubform[0].Page1[0].f1_35[0 Text
This field appears to be missing a label. Please refer to the form instructions or context for the correct information to enter here.
topmostSubform[0].Page1[0].f1_37[0 Text
This field appears to be missing a label. Please refer to the form instructions or context for the correct information to enter here.
Use of Proceeds
b Buildings and structures 31b Text
Enter the amount allocated to buildings and structures for the bond issue.
31c Text
Enter the amount for the specified category in line 31c.
e Other. Describe (see instructions) Text
Describe any other uses of the bond proceeds not covered in the previous categories.
Veterans' Mortgage Bonds
50a Amount of issue of qualified veterans' mortgage bonds. 50a Text
Enter the amount of issue of qualified veterans' mortgage bonds.
b Enter the state limit on qualified veterans' mortgage bonds 50b Text
Enter the state limit on qualified veterans' mortgage bonds.