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ANNUAL REPORT
OF THE
FIRE DISTRICT TREASURER
in the
TOWN OR TOwNs OF ............... ---~--~.---~-...~'~.-~'~--~--~'---~)- .........................................................................
COUNTY OF ................................... ..~...~ .--~[.----~'- --- .~--~.--~- ............................................................................
for the
FISCAL YEAR ENDING ................... ~-.~-.W~-,------~--~----..~r-------/-~--~--~ ......................................................
This l~eport must be filed on or before March first.
The Fiscal Year is from January first to December thirty-first.
General Municipal Law ~ Section 30-31.
Town Law ~ Section 181
DIVISION OF MUNICIPAL AFFAIRS
COMPTROLLER'S OFFICE
RECEIPTS ' ·
REVENUE RECEIPTS:
Property Taxes: (When district is located in more than one 'town, the property taxes received from each
'town should be shown.)
Town of ................. .,?.~..~/t'.a.~..a. ...............................
Town of ............................................................................................................
Town of ............................................................................................................
Town of ................................................................... '- ........................................
Total Taxes ............................................................ (3)
Other Revenue:
Fire Protection Services Rendered Outside District ...... $ ......... L ..................
Emergency or General Ambulance Service Rendered Outside
District .........................................................................
Refunds (Insurance, Etc.) ...................................... ~-~.~.:~..~......
All Other (Itemize) ...............................................................
Total Other Revenue ................................................... (7) $ ...... .~...~.~..~....~..
Total Revenue Receipts ............................................... (10) $.~,.~f~.....~.,?/~ ..~-
NON-REVENUE RECEIPTS:
Notes Issued ......................................... (9) $ ............................
Premium and Accrued Interest on Notes ................ (9) ............................
Bonds Issued ......................................... (8) ............................
Premium and Accrued Interest on Bonds ................ (8) ............................
Total Non-Revenue Receipts ............................................ ~.~.~.,.!..~.__
TOTAL RECEIPTS ................................................. * ............................
I~ALANCE AT BE~INNIN~ OF YEAR 0~-~--) ......... $ .......
..~'.~.~t'.r~t~.~.~.~ Fund or Account ............... /.~..~..~.~..
............................................ Fund or Account ..........................................
TOTAL BALANCE ................................................. (13)
TOTAL RECEIPTS AND BALANCE ................................ (14) ~--~,-'~--~--/--*.~-9
:2
· ' DISBURSEMENTS ' ,
CURRENT EXPENSES:
Salaries and Wages ...................................... $....~.~~./~.,...~...~...
Maintenance and Repair (Bldgs., Equip.) ....................... ~..~.~.~.~.~.~.
Light and Heat .............................................. /..~..~.~.~...~..
Insurance ................................................... ~.~..~. ~.,...~..~.
Advertising .........................................................................
Printing ..............................................................
Telephone ...................................................... ~..~....~..~
Premium on Treasurer's Bond .......................................... ./..~..:.~..~.~'
Dues Paid to New York State Association of Fire Districts ............ ~.~..:....~.
Legal Fees ..........................................................................
Payment to Fire Department or Company for Services Rendered
Outside District ...................................................................
Other Expenses (Specify) ./~.)(..~.g~/¥.~.../~.~.~77 .......... .~..~..~..~.,.~,~'..~..
....................... Z~is..e.~-A~. ~... ~. ~ ..........................
...................... /~. ~.~. ~.c.~.~.b~.~ ......................... .~(~..~..:~.~
Total Current Expenses .................................................(1) $~..~...~..~...d,...~../~.
CAPITAL OUTLAY:
Purchase of Apparatus or Equipment ...................... $..~..~..~...~.e...~..A~.
Purchase or Erection of Buildings .....................................................
T~tal Capital Outlay .................................................... (2) $.~.~.'~..~....~..~.~..
DEBT SERVICE:
Payment of Notes-- Principal .......................... (3) $ ............................
Payment .of Bonds -- Principal ......................... (3) ...~...~...~...~.:../~'~ .....
Interest on Notes and Bonds ........................... (4) .........
Total Debt Service ......................................................
TOTAL DISBURSEMENTS .........................................
($) $ ............................
BALANCE AT CLOSE OF YEAR (19.~.~_) ............... $...~_~4~.....~..~..~.6~..~..
............................................ Fund or Account ..............
............................................ Fund or Account ..........................................
TOTAL BALANCE .................................................
TOTAL PAYMENTS AND BALANCE ...............................
' ' GENERAL INFORMATION · ·
Is the District governed by the Town Board or a separate Board of Fire District Commissioners? ................
.................... ...................
Chairman of the Board P.O. A~tdress
DETAILED STATEMENT OF INDEBTEDNESS
Notes (Principal Only): Outstanding Issued Redeemed Outstanding
Beginning During Total During End of
Types of Notes of Year Year Year Year
Tax Anticipation .................. $ ................. $ .................. $ .................. $ .................. $ ..................
Revenue Anticipation .................................................................................................................
Budget ..............................................................................................................................
Capital ................................................................................................................................
Bond An,ticipation .....................................................................................................................
Deferred Payment .....................................................................................................................
TOTAL -- NOTES .............
Bonds (Principal Only) Outstanding Issued Redeemed Outstanding
(Show Each Issue Sepa- Year o£ Interest Beg4nning During During End of
rately by Title and Purpose Issue Rate o£ Year Year Year Year
o£ Each)
.............................................................................. $ .................. $ .................. $ .................. $ .................
~a~.~.~..B'~.kl,,.~..... l.~.d~... ...... -G--~-~- ..... ,~..a..e.,.._a=. ..................... l_.__~.. ..,...a~.. ..l.a~...~
TOTAL-- BONDS..
TAX RATE AND ASSESSED YALUATION OF FIRE DISTRICT
(The Assessed Valuation multiplied by the Tax Rate should, generally, agree with the amount shown for
Property Taxes on page
Tax Rate Per $1,000 Assessed Valuation
Town of ............ ............................................. $ ........ .............
Town of ....................................................................................................................................................
Town of ....................................................................................................................................................
Town of ...................................................................................................................................................
TOTAL--ASSESSED VALUATION ............................... $~-/.~.Z~.~-~-.~
CERTIFICATE OF FIRE DISTRICT TREASURER
I, ...../~A.go.t,..O__....7:,_...l~..t~r;li. Aet.,a.~.D. ............. , do hereby certify ghat I am the Treasurer of
(Print Nams)
...~.O.U..'~__/Ld.~- ...... i Fire District located in the Town or Towns of: ......... .~..~..~..~..~.~..~..O. ................ ,
.................................................... , ..................................................... County of ..... ,~.~. ~ ..~...o../~ ~ ................
and that the foregoing statement of the receipts and payments of such Fire District for the fiscal year ending
............ ~.~..C~..2./'. .................. 195.~.., is true to the best of my knowledge, information and belief.
Dated: ...... [~.Z¥~...~...~ ................ , 195..-~-. -~-~-.--~ ...............
P.O. Addr ess~l~'..'