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COUNTY CODE
C~ASS CODE
TOWN NUMBER
DISTRICT NUMBER
STATE OF NEW YORK
ANNUAL REPORT
OF THE
FIRE DISTRICT TREASURER
NA~Vn~ OF mS~'aICT ,,COVr// OL a ,F / fiE. D/s
in the
TOWN OR TOWNS OF
COUNTY OF
for the
YEAR ENDING DECEMBER 31, 196~''''~
This Report must be filed on or before March first
The fiscal year is from January first to December tbJr~-r~t
General Municipal Law- Sections 30-31
Town Law -- Section 181 (3)
DIVISION OF MUNICIPAL AFFAIRS
DEPARTMENT OF AUDIT AND CONTROL
ALBANY, NEW YORK
10~26~5-3M (5Dq83)
RECEH~TS AND BEGINNING BALANCES
GENERAL FUND (Column 18-1)
Real Property Taxes: ~acb town in which fire district is located)
Town of ~ $ ~$&g:.
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 from whom
contract payments are received)
District ..........
District ..........
All Other: Interest on Deposits ..................................
Rentals ........................................................
Refund of Expenses ~. ~.
Total Oth;r Rec~ipts[~ .................................................................................................... (7)
Notes Issued (Budget, Tax Anticipation, Revenue Anticipation) ............................................ (9)
Transfer from Capital Fund .................................................... $ -~' 3/ ? ~ ~:
Transfer from ..........
Total Transfers ........................................................................................................ (12)
Total Receipts, General Funa ..................................................................................................
Balance at Beginning of Year, General Fund ........................................................................ (13)
W~tal Receipts and Balance, General Fund ............................................................................ (14) $
CAPITAL FUND (Column 18-~)
Bonds Issued .............................................................................................................................. (8) $
Premium and Accrued Interest on Bonds ................................................................................ (8)
Capital Notes Issued .................................................................................................................. (9)
Bond Anticipation Notes Issued .............................................................................................. (9)
Interest and Profit on Deposits and Investments .................................................................. (7)
Transfer from General Fund ..................................................
Transfer from ..........
Total Transfers ........................................................................................................ (12)
Total Receipts, Capital Fund .................................................................................................. $
Balance at Beginning of Year, Capital Fund .......................................................................... (13)
Total Receipts and Balance, Capital Fund ............................................................................ (14)
ff.~d~e'~'~s~. RIZSERVE FU~ (Cohunn 18-3)
([nsert Title)
Interest and Profit on Deposits and Investments .................................................................. (7) $
Transfer from General Fund .................................................. $
Transfer from Reserve Fund ..................................................
Transfer from
Total
Transfers
........................................................................................................ (12)
Total Receipts, Reserve Fund ................................................................................................ $.~
Balance at Beginning of Year, Reserve Fund ........................................................................ (13) --
Total Receipts and Balance, Reserve Fund .......................................................................... (14) $
TRUST AND AGENCY FUNDS
New York State Income Taxes Withheld ..................................................................................
United States Income Taxes Withheld ......................................................................................
Social Security Taxes ................................................................................................................
Foreign and Alien Fire Insurance Taxes ................................................................................
Other: (specify)
Total Receipts, Trust and Agency Funds ................................................................................
Balance at Beginning of Year, Trust and Agency Funds ......................................................
Total Receipts and Balance, Trust and Agency Funds ........................................................
NOTE: If more than one reserve fund has been established, attach a sheet showing the transactions of each additional reserve.
PAYMENTS AND ENDING BALANCES
GENERAL FUND (Column 18-4)
Current Expenses:
Personal Services ..........................................................
Hydrant Rental ................................................................
Payment to Fire Department or Company for Services
Provided Outside the District: (specify)
Payment to Outside Agency for Services Within
the District: (specify agency)
.'J 9 ~0. a'D __
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 $ ~-~7,~{ff. ~
Transfer to Reserve Fund ......................................................
Transfer to ..........
Total Transfers .......................................................................................................... (7) TM
Total Payments, General Fund ..................................................................................................
Balance at End of Year, General Fund .................................................................................... (8)
Total Payments and Balance, 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 .......................................................
Transfer to ..........
Total Transfers ........................................................................................................ (7)
Total Payments, Capital Fund ..................................................................................................
Balance at End of Year, Capital Fund .................................................................................... (8)
Total Payments and Balance, Capital Fund .......................................................................... (9)
~ RESERVE FUI%~ (Column 18-6)
(~ser t Title)
Purchase of Apparatus and Equipment .................................................................................... (2)
Construction of Buildings .......................................................................................................... (2)
Transfer to Reserve Fund ...................................................... $
Transfer to ..........
Total Transfers .......................................................................................................... (7)
Other Payments: (specify)
Total ~ayments, Reserve Fund ..................................................................................................
Balance at End of Year, Reserve Fund .................................................................................... (8)
Total Payments and Balance, Reserve Fund ...................................... : ................................... (9)
TRUST AND AGENCY FUNDS
s z._a .'/-
New York State Income Taxes Withheld ...................................................................................
United States Income Taxes Withheld .....................................................................................
Social Security Taxes ................................................................................................................
Foreign and Alien Fire Insurance Taxes ................................................................................
Other: (specify)
Total Payments, Trust and Agency Funds ..............................................................................
Balance at End of Year, Trust and Agency Funds ................................................................
Total Payments and Balance, Trust and Agency Funds ........................................................
RECONCILIATION OF CASH AND BANK BALANCES
Cash Balaneea by Fudd at End of Year:
General Fund (from page 3) ...................................................................................................................................... $ ~ ~'~.. /,~
Capital Fund (from page 3) ........................................................................................................................................ ~i~
Reserve Fund (from page 3) ....................................................................................................................................
Trust and Agency Fund (from page 3) ....................................................................................................................
Total - All Funds ........................................................................................................................................ SJ~b~L~
Bank Balances at End of Year:
Bank Outstanding Net Bank
Balance Checks Balance
Name and Location of Bank
It
Petty Cash
Cash on Hand
Total Bank Balances and Cash on Hand
FUND Description of Investment Purchase Price
DETAILED STATEMENT OF INDEBTEDNESS
Outstanding ] Issued Redeemed Outstanding
NOTES Beglntfing During Total During End
of Year year Year of year
Tax or Revenue Anticipation
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 ami Purpose) Issue of year Year Year of Year
Total- Bonds XXXX XXXX
COMPUTATION OF REAL PROPERTY TAXEr
Assessed Valuation Tax Rate Amount of Tax
TOWN of Fire District per $1,000 (Assessed Valuation
~.~ ~ 1_ ~ within Town of Assessed Valuation multiplied by Tax Rate)
District Total $ XXXXXXX $
NOTE: Amount o/tare shown for each town in last column should agree with corresponding ta~ receipts shown at top o/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
CI,AIMS PAYABLE
Amount of Unpaid Claims of District at End of Year $~_.~_.
CHAIRMAN OF THE BOARD:
N me 14/A rff · C.
CER'I'I~'ICATE OF ~1~ DISTRICT TREASURER
I, ~- 7~_ ffI'C~O]~O , do hereby certify that I am the Treasnrer of ~aO~O~O
' ' (~l~ase Print or T~e~
Fire District located in the To~ or Towns of: '~0 ~ ~ ~ ~ ~
., Coua~ of ~ ~ ~ ~ ~ ~ , and ~ac~e foregoing statement of ~e receipts and
payments of such Fire District for the fiscal ye~ ended Decem~r 3~, 10~, ig t~e to the best of my know]edge, iRfo~m~ofl ~nd b~lief.
Datdd ~° ~q
Signature
· 196~. 4 P.O. Address~