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FOR AUDIT AND CONTROL USE
Report Year Col. I-
Control (X) Col. 13
DEPARTMENT OF AUDIT AND CONTRO
DIVISION OF MUNICIPAL AFFAIRS
ALBANY, NEW YORK
ANNUAL REPORT
OF THE
FIRE DISTRICT TREASURER
FOR THE YEAR ENDED DECEMBER 31, 196_. _
rf
*TOWN OR TOWNS OF
COUNTY OF
THE DISTR~IcT~VE RNED BY: (Check one)
L~Separate Board of Fire Commiss~oners or
IN THE
lc~
[~ Town Board
AUTHORIZATION
Article 3, Section 30 of the General Municipal Law
"1. *** every *** fire *** district *** shall annually make a report of its financial condition to the comptroller.
Such report shall be made by the *** treasurer of each fire *** district
5. All reports shall be certified by the officer making the same and shall be flied with the comptroller within
sixty days after the close of the fiscal year of such *** district ***. Every such officer shall also, within
sixty days after the expiration of his term of office, or his resignation or removal therefrom, make a report to
the comptroller of the financial condition of such *** district *** on the date of the expiration of his term of
office, or his resignation or removal from office, as the case may be. The refusal or wilful neglect of such
officer to file a report as herein prescribed shall be a misdemeanor and subject the financial officer so refusing
or neglecting to a penalty of five dollars per day for each day's delay beyond the sixty days to be paid on de-
mand of the comptroller."
CERTIFICATE OF FIRE DISTRICT TREASURER
(Please Print or Type)
Fire District and that the following report is a true and correct statement of the financial transactions of such
Fire District for the year ended December 31, 196~
Signature
Dated f///S . ,9~..~ P.O. Address
CHAIRMAN OF THE BOARD
Name . J~,~,,{~-,, ~,~-~.-NI-. Address~.~l~ ~;b~,~l
GENERAL FUND
RECEIPTS AND BEGINNING BALANCE
Al0 Real Property Taxes (must agree'with Total Tax Computation on page 4) ........................ (001 I).$
Other Revenues:
A20 State Aid for Loss in Railroad Tax Revenue ........
A30 Federal Aid for Civil Defense ..............................
A40 Charges for Fire Protection, Other Services ..........
ASI Interest, Earnings on Deposits and Investments
A52 Rentals ..................................................................
A53 Sale of Equipment ..................................................
A54 Gifts and Donations ..............................................
A55 Refunds of Expenses ............................................
A59 Miscellaneous Revenues (specify)
311. oo
Total Other Revenues ........................................................(0071)
Notes Issued:
A64 Budget .................................................................... $
A65 Tax Anticipation ....................................................
A66 Revenue Anticipation ............................................
Total Notes Issued ............................................................ (009l)
ASI Transfer from Capital Fund ......................................
A82 Transfer from Reserve Fund
Total Transfers .................................................................. (0121)
Sale of Investments ................................................................................................................
Total Receipts ..............................................................................................................
Balance at Beginning of Year ....................................................................... ~.~..t:,.? ....... (0131) ///-/~ o.~'
Total Receipts and Balance .............................................................................. (0141) $
PAYMENTS AND ENDING BALANCE Current Expenses:
Al00 Personal Services ..................................................$.
A400 Contractual and Other Expenses ............................
A601 Hydrant Rental ......................................................
A602 Fire Department or Company Services ..................
A603 Fire Protection ......................................................
A610 Judgments and Claims ............................................
A628 State Retirement System ........................................
A629 Police and Fire Retirement System ......................
A630 Workmen's Compensation Insurance ......................
A633 Social Security ......................................................
A636 Medical, Surgical and Hospital Care ......................
A638 Blanket Accident. Insurance ..................................
Total Current Expenses ...................................................... (1014)
A200 Equipment .................................................................................................................. (1024)
Debt Service:
A680 Interest on Bonds .................................... (1044) $
A681 Interest on Notes .................................... (1144)
A690 Redemption of Bonds ................................ (I 034) "~i
A691 Redemption of Notes .............................. (I 134)
Total Debt Service ............................................................................
AS01 Transfer to Capital Fund . $-
A802 Transfer to Reserve Fund "~.i~ii~.'~:.~ii~/.~--~
Total Transfers .................................................................. (1074)
Purchase of Investments ........................................................................................................
Total Payments ............................................................................................................ $.
Balance at End of Year (should agree with page 4) ....................................................
Total Payments and Balance .............................................................................. (1094)
/ ~ ,.; c1-1.o £-
NOTE: Numbers in parenthesis are for Department of Audit and Control use only.
CAPITAL FUND
RECEIPTS AND BEGINNING BALANCE
HSl Interest and Earnings on Deposits and Investments ................................................. (0072) $.
B60 Bonds ' (0082)
H61 Premium and Accrued'Interest on Bonds .................................................................. (0182)
H62 Capital Notes ............................................................................................................ (0092)
H63 Bond Anticipation Notes ............................................................................................ (0192)
H82 Transfer from General Fund ...................................................................................... (0122)
Other (specify)
Total Receipts .................................................................................................. $.
Balance at Beginning of Year .................................................................................... (0132)
Total Receipts and Balance ............................................................................ (0142) $,
PAYMENTS AND ENDING BALANCE
H200 Equipment ................................................................................................................ (1025) $.
11500 Real Property .......................................................................................................... (1125)
H681 Interest on Bond Anticipation Notes ...................................................................... (1145)
H693 Redemption of Bond Anticipat'ion Notes .................................................................. (I 135)
HSI0 Transfer toGen~ral Fund ........................................................................................ (1075)
Other (specify)
Total Payments .............................................................................................. $
Balance at End of Year (should agree with page 4) ................................................ (J08S)
Total Payments and Balance .......................................................................... (1095) $
RESERVE
FUND(S) . . ~ .,~ ,,-.r" ~ ~,
In~t ~1~ ~eser~ Insert Title of Re~/erve
$_
RECEIPTS AND BEGINNING BALANCE
M51 Interest, Earnings on Deposits and Investments ...... (0073) $ _~"~, ~ o I
M53 Sale of Assets .......................................................... (0173)
M82 Transfer from General Fund .................................... (0123)
M83 Transfer from Reserve Fund .................................... (0223)
Other (specify)
- ( )
Total Receipts ............................................. $
Balance at Beginning of Year .................. ,.....1 ........... (0133)
Total Receipts and Balance .......................... (0143) $
PAYMENTS AND ENDING BALANCE
M200 Equipment .............................................................. (1026) $. $
MS00 Real Property ........................................................ (I 126)
M802 Transfer to Reserve Fund ...................................... (I 176)
M810 Transfer to General Fund ...................................... (1076)
Other (specify)
( )
Total Payments .......................................................... $ $.
Balance at End of Year (should agree with page 4) .. (1086) ~ 303 ~ ~
Total Payments and Balance .......................... (1096) $ ~ ~c~ ~' I $.
$ 3~, 3o I
TRUST AND AGENCY FUNDS
RECEIPTS
$
New York State Income Taxes .......................................... T2
Federal Income Taxes ...................................................... T3
Social Security Taxes ...................................................... T't
Foreign Fire Insurance Taxes .......................................... T5
Group Insurance Deductions .............................................. T6
Other (specify)
PAYMENTS
Total Receipts ........................................................ $ $
Balance at Beginning of Year ..........................................
Total Receipts and Balance .................................. $
Total Payments ..................................................................................................................... $
Balance at End of Year (should agree with page 4) .......................................................................
Total Payments and Balance ................................................................................................. ~
RECONCILIATION OF CASH AND BANK BALANCES
Cash Balances by Fund at End of Year: .
General Fund (should a§reewith page 2) ................................................................................ $
Capital Fund (should agree with page 3) ................................................................................
Reserve Fund (should agree with pa§e 3) ................................................................................ ~.
Trust and A§enc¥ Fund (should agree with page 3) ................................................................
Total- All Funds ............................................................................................................
Bank Balances at End of Year:
Name and Location of Bank
Bank Balance Outstanding Checks Net Bank Balance
Totals .................................... $
Petty Cash ............................................................................................................................
Cash on Hand (dote deposited ) ..................................................
Total Bank Balances and Cash on Hand ........................................................................
INVESTMENTS HELD AT DECEMBER 31, 196
Fund
Description of investment
Purchase Price
COMPUTATION OF REAL PROPERTY TAXES
Assessed Valuation Tax Rate Amount of Tax
Town of Fire District per $l ,000 (Assessed Valuation
'-r~ (~,~ A/ within Town of Assessed Valuation multiplied ~, Tax
District Total J$ $ $ =
Audit and Control Use Only - Total Assessed Valuation ............................................ (2100) $
NOTE: Total amount of tax shown in last column should agree with the real property taxes shown at top of page
DETAILED STATEMENT OF INDEBTEDNESS
Bonds Year Outstanding Issued Redeemed Outstanding
(Show each issue separately by of Interest Beginning During During End
Title and Purpose) [ssue Rate of Year Year Year of Year
Total Bonds XXXX XXX $ /~OO,~ $ $ 3~ O~ ~ Is'
Audit and Control Use Only - Total Bonds as of December 3{ ..................................... (2200) $
Tax or Revenue Anticipation XXXX XXX $ $ $ $
Budget XXXX XXX
Capital XXXX XXX
Bond Anticipation XXXX XXX
Total Notes XXXX XXX $ $ $
Audit and Control Use Only - Total Notes as of December 31 .................................... (2300) $
RECEIV,~BLES CLAIMS PAYABLE
Amount Due District at End of Year $ ~) Amount of Unpaid Claims of District at End of Year