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COUNTY CODE
c~Ass CODE
TOWN NUMBER
DISTRICT NUMBER
STATE OF NEW YORK
ANNUAL REPORT
OF THE
NAME OF DISTRICT .~c,'T']'/O~ f~ I" I R ff- It~ } ~ "~ f~ / (L. '~ '~
in the
TOWN OR TOWNS OF
COUNTY OF
YEAR ENDING DECEMBER 31~ 196¢
This Repo~ must be fded on or before March first
The ~ year is from Januai7 first to December thlriy.~t
General Municipal Law--Sections 30-31
Town Law ~ Section 181 (3)
DIVISION OF MUNICIPAL AFFAIRS
DEPARTMENT OF AUDIT AND CONTROL
ALBANY, NEW YORK
10- 26-66,.6M
AND BEGINNING BALANCES
GENF.~*AL FUND (Column 1~-1)
Real Property Taxes: (Show taxes from eacb to~vn in wblcb fire district is located)
Town of ,%'0 ~' '7' ti ~/-/9
Town of ..........
Town of ..........
Town of ..........
Total Real Property Taxes .................................................................................... (1) $
Other Receipts:
State Aid for Loss in Railroad Tax Revenue ..................... $
Federal Aid for Civil Defense
Fire Protection and Other Services Provided Out-
side the District: (list each District /rom whom
contract payments are received)
District ..........
District ..........
Ail Other: .Interest off Deposits ..................................
'Rentals
Refund of Expenses ..................................
Total Other Receipts ........................................................................................ ' ............. (7)
Notes Issued (Budget, Tax Anticipation, Revenue Anticipation) ............................................ (9)
Transfer from Capital Fm~d ....................................................
Transfer from ..........
Total Transfers ........................................................................................................ (12)
Total Receipts, General Fund ..................................................................................................
Balance at Beginning of Year, General Fund ........................................................................ (13)
Total Receipts and Balance, General Fund ............................................................................ (14)
CAPITAL FUNI} (Column 18-2)
Bonds Issued .............................................................................................................................. (8) $
Premium and Accrued Interest off Bonds ................................................................................ (8)
Capital Notes Issued .................................................................................................................. (9)
Band Aflricipatlon Notes Issued ..............................................................................................(9)
Interest and Profit an Deposits and Investments .................................................................. (7)
Transfer from General Fund ..................................................
T~ansfer from ..........
Total Transfers ........................................................................................................ (12)
Total Receipts, Capital Fund .................................................................................................. $
Balance at Beginning of Year, Capital Fund .......................................................................... (13)
Total Receipts and Balance, Capital Fund ............................................................................ (14) $
FUND (Column 18-3)
Interest and Profit on Deposits and Investments .... I..~.~3,'..~..~....~.......Zff.~:L,(.~. ............. (7)
Transfer from General Fund .................................................. $
Transfer from Reserve Fund ..................................................
Transfer from ..........
Total Transfers ........................................................................................................ (12)
Total Receipts, Reserve Fund ................................................................................................ S g '~ ~'.~, ~:g~
Balance at Beginning of Year, Reserve Fund ........................................................................ (13) ,~"~ ~,-'~ C'~
Total Receipts and Balance, Reserve Fund .......................................................................... (14) $ /~' / _9 ~ ~ ~ ~
TRUST AND AGENCY FUNDS
New Yosk State Income Taxes Withheld .................................................................................. $
United States Income Taxes Withheld ......................................................................................
Social Seettrity Taxes ................................................................................................................
Foreign and Alien Fire Insurance Taxes ................................................................................
Other: (specily)
Total Receipts, Trust and Agency Funds ................................................................................ $,
Balance at Beginning of Year, Trust and Agency Funds ......................................................
Total Receipts and Balance, Trust and Agency Funds ..................................................... ... $~
NOTE: I! more than one reserve /und has been established, attach a sheet showing the transactions o! each additional reserve.
2
PAYMENTS AND ENDING BALANCES
GENERAL FUND (Column 18-4)
Versan.l Services .......................................................... ,
Hydrant Rental ................................................................ 7
Payment to Fire Department or Company for Services
Provided Outside the District: (specify)
Payment to Outside Agency for Services Within
the District: (specify agency)
Other Expenses: ..........
Total Current Expenses ......................................................
Purchase of Apparatus and Equipment ................................................ ?....~,..~..-~..~..~...-~- ....... (2)
Debt Service:
Redemption of Bonds .......................................... (3)
Redemption of Notes .......................................... (3)
Interest on Bonds and Notes .............................. (4)
Total Debt Service ....................................................................................................
Transfer to Capital Fund ........................................................ $.
Transfer to Reserve Fund ......................................................
Transfer to ..........
Total Transfers .......................................................................................................... (7)
Total Payments, General Fund ...................................................... : ..........................................
Balance at End of Year, General Fund .................................................................................... (S)
Total Payments and Bhlance, General Fund .......................................................................... (9)
CAPITAL FUND (Column 18-5)
Purchase of Apparatus and Equipment .................................................................................... (2) $
Construction and Purchase of Buildings ...................................................................................... (2)
Redemption of Bond Anticipation Notes .................................................................................. (3)
Interest on Bond Anticipation Notes ........................................................................................ (4)
Transfer to General Fund ....................................................... $
Tru~s let to ..........
Total Transfers ........................................................................................................ (7)
Total Payments, Capital Fund ....................... . ..........................................................................
Balance at End of Year, Capital Fund .................................................................................... (8)
Total Payments and Balance, Capital Fund ............................
~_~.'~'F~_-~ RESERVE FUND (Column 18-6)
On~rt Title)
Purchase of Apparatus and Equipment .................................................................................... (2)
Construction of Buildings .......................................................................................................... (2)
Transfer to Reserve Fund ......................................................
Transfer to ..........
Total Transfers .......................................................................................................... (7) $.
Other Payments: (speci/y)
Total Payments, Reserve Fund ..................................................................................................
Balance at End of Year, Reserve Fund ................................................................................. (8)
Total Payments and Balance, Reserve Fund .......................................................................... (9)
TRUST A_ND AGENCY FUNDS
New York State Income Taxes ~ithheld ................................................................................... $
United States Income Taxes ~ithheld .....................................................................................
Social Security Taxes ................................................................................................................
Foreign and Alien Fire Insurance Taxes ................................................................................
Other: (speci/y)
Total Payments, Trust and Agency Funds ..............................................................................
Balance at Emi of Year, Trust and Agency Funds ................................................................
Total Payments and Balance, Trust and Agency Funds .......
RECONCILIATION OF CASH AND BANK BALANCES
Cash Balances~by Fund at End of Year:
General Fund (from page 3) ......................................................................................................................................
Capital Fund (from page ~) ........................................................................................................................................
Reserve F~d (~om page 3) ....................................................................................................................................
Trust and Agency F~d (kom page 5) ....................................................................................................................
Total- All Funds ........................................................................................................................................
Bank Balances at End of Year:
Name and Location of Bank
Bank Outstanding Net Bank
B~alance Checks Balance
Petty Cash
Cash on Hand
Total Bank Balances and Cash on Hand
FUND Description of Investment Purchase Price
. DETAILED STATEMENT OF INDEBTEDNESS
Outstanding I IsSued Redeemed Outstanding
NOTES Beginning During Total During End
of Year Year year of year
Tax or Revenue Anticipation I$ $ $ S $
Budget
Capital
Bond Anticipation
Total - Notes $
BONDS Year Outstanding Issued Redeemed Outstanding
(Show each issue separately by of Interest Beginning During During End
Rate
Title and Purpose) Issue of year Year year of Year
S
Total- Bonds ~/~d~.~
XXXX
×x×× Is Is ls
COMPUTATION OF REAL PROPERTY TAXES
Assessed Valuation Tax Rate Amount of Tax
TOWN of Fire District per $1,000 (Assessed Valuation
within Town of Assessed Valuation multiplied by T~x Rate)
/
District Total [ $ XXXXXXX
NOTE: Amount of tax shown for each town in last column should agree witb corresponding tax receipts shown at top of page 2.
RECEIVABLES
Amount Due District at End of Year $
THE DISTRICT IS GOVERNED BY: (Check one)
[] Town Board
[] Separate Board of Fire District Commissioners
CLAIMS PAYABLE
Amount of Unpaid Claims of District at End of Year
CHAIRMAN OF THE BOARD:
$.me Whl TEft C,
/ -
CERTIFICATE OF ~H~E DISTRICT TREASURER
I, ~/,~7~, ~I'~H AA t~ ~l D doherebycertifythatI amtheTreasurerof ~O ff~ D
' (Please'P~in~ o~ T~e) ' ' ~
Fire District located in the To~ or Towns of: ~ L, '~ ~ ~
, cou. of K . of
payments of such Fire District for the fiscal ye~ ended Deeem~r 31, 196~, is tree to the best of my knowledge, information and belief.