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pdfF-28 (2004)
OMB No. 0607-0585: Approval Expires 03/31/2005
2004 Annual Survey of County and Municipal Government Finances
U.S. DEPARTMENT OF COMMERCE
In correspondence pertaining to this report, please refer to the ID printed above your address.
Economics and Statistics Administration
U.S. CENSUS BUREAU
RETURN TO:
U.S. Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001
If you have any questions, please call
1–800–242–4523
weekdays, 7:00 a.m. to 5:00 p.m. EST.
Questions can also be emailed to:
govs.finstaff@census.gov
Please correct any errors in name, address, or ZIP Code.
GENERAL INSTRUCTIONS
Before filling out this form, please read carefully each part and all related definitions and instructions.
Note especially:
1. Please report amounts covering all funds and accounts of your government except for any employee-retirement
funds administered by your government. Include bond redemption and interest funds, and construction or
development funds, as well as current funds. Exclude refunds and transfers between funds or accounts of your
government.
2. As this form is used for various kinds of governments, some of the items may not apply to your government.
However, read carefully the definition of each item to determine whether it applies to any of your government’s
transactions.
3. Do not delay reporting to await finally audited figures, if substantially accurate figures can be supplied on a
preliminary basis.
4. You may report on either a cash or accrual basis.
..Part 1..
ENDING DATE OF FISCAL YEAR
Mark (X) in the appropriate box below to indicate the ending date of your government’s fiscal year
(12-month accounting period) and report data for this period only.
Use this fiscal year even though a more recent one may be available.
2003
July
August
September
2004
October
November
December
January
February
March
April
May
June
Please continue on the next page
1/26
..Part 2..
Page 2
TAX REVENUES
Report collections during the fiscal year indicated in Part 1 from all taxes imposed by your government.
Include current and delinquent amounts, penalties, and interest.
Exclude receipts from service charges, special assessments, interest earnings, fines, and any other sources
that are not taxes or licenses.
1. Property taxes - All taxes on property, real or personal. Report collections
during the fiscal year from all levies for all funds of your government and its
T01
agencies………………………….………………………………………………………….
$
Tax Revenues
,
,
.00
Include levies for debt service, pension funds, and other funds or purposes.
Exclude any taxes you collected on behalf other governments and taxes not
measured by value.
2. Local sales taxes - Taxes on goods and services, measured as a percent of sales
or receipts or as an amount per unit sold (gallon, package, etc.)
Include only taxes imposed by your government.
Exclude shares of taxes imposed by another government (Report in Part 3 ).
T09
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
F. Other licensing and permit taxes, specify::…………………………………………… $
,
,
.00
A. General sales tax………………………………………………………………….. .
T10
B. Alcoholic beverages sales tax………………………………………………………
T11
C. Amusements sales tax………………………………………………….…………..
T13
D. Motor fuels sales tax……… ……………………………………………………….
T14
E. Parimutuels tax…..……………………………………………………………….. .
T15
F. Public utilities sales tax………….…………………………………………………
G. Tobacco products tax…..…………………………………………………………..
T16
T19
H. Other sales tax, specify: ……. ………………………………………………………
3. Licensing and permit taxes - (e.g., license and inspection charges on occupations,
businesses, animals, vehicles, etc)
T20
A. Alcoholic beverages licensing and permit taxes.…………………………………
B. Amusements licensing and permit taxes …… …………………….………. ……
C. Motor vehicles licensing and permit taxes ………………………………….……
T21
T24
T27
D. Public utilities licensing and permit taxes………………...………………………
T28
E. Occupation and business licensing and permit taxes (not reported above)….
T29
Please continue on the next page
1/26
Page 3
..Part 2..
TAX REVENUES
CONTINUED
4. Local income taxes
T40
A.
Local personal income, payroll, or earnings tax ……..…………….………..
B.
Local corporation net income tax………..……………………………………..
A.
Documentary and stock transfer tax…………………………….. …………..
B.
Other taxes, specify:…..…………………………………………………….….
T41
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
5. Other taxes
T51
Please continue on the next page
T99
1/26
Page 4
..Part 3..
INTERGOVERNMENTAL REVENUES
Report all amounts received by your government from other governments during the fiscal year
indicated in Part 1.
Include grants, shares of taxes imposed by other governments, payments in lieu of taxes, and
reimbursements for services performed for other governments.
Exclude loans, any taxes imposed by your government which were collected for it by another
government (Reported in Part 2 ) and receipts from utility sales to other governments (Report in Part 4 ).
From the State –
Include any amounts financed wholly
or in part from Federal grants to the
State (i.e., pass-throughs).
From other local
governments
1. Streets and highways
D46
2. Education
D21
3. Public welfare
(including Medicaid)
D79
4. Health and/or hospitals
D42
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
5. Housing and community D50
$
development
,
,
.00
$
,
,
.00
$
,
,
.00
6. Water supply system
D91
7. Sewerage
D80
From the Federal
government directly
Exclude collection fees.
C46
C21
C79
C42
C50
C91
C80
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
Please continue on the next page
B46
B21
B79
B42
B50
B91
B80
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
1/26
Page 5
..Part 3.. INTERGOVERNMENTAL REVENUES
CONTINUED
From the State –
Include any amounts financed wholly
or in part from Federal grants to the
State, (i.e. pass-throughs).
From other local
governments
8. Electric power system
D92
9. Gas supply system
D93
10. Mass transit rail
and/or bus system
D94
11. Airports
D01
12. Natural resources
D59
13. General support
(unrestricted)
D30
Exclude collection fees.
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
C92
C93
C94
C01
C59
C30
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
B92
B93
B94
B01
B59
B30
From the Federal
government directly
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
,
.00
$ ,
$
,
,
.00
$
,
,
.00
14. All other, specify
D89
C89
B89
Please continue on the next page
1/26
Page 6
..Part 4..
REVENUES - OTHER THAN TAX AND INTERGOVERNMENTAL REVENUES
Report other revenues received by your government during the fiscal year reported in Part 1.
Include revenues of all funds except those noted in any separate instructions included with this form.
Exclude refunds and transfers between funds and accounts of your government.
1. Utility sales revenues - Gross receipts of any water, electric, gas, or transit
systems operated by your government, from utility sales and charges.
Include amounts received from the sale of utility commodities and services to the
local, State, or the Federal government.
Utility Sales Revenues
A91
A. Water supply system…………………………………………………….
$
,
,
.0 0
$
,
,
.0 0
$
,
,
.0 0
$
,
,
.0 0
A92
B. Electric power system……………………………………………………
A93
C. Gas supply system……………………………………………………….
A94
D. Transit or bus system……………………………………………………
2. Other sales and service revenues - Gross receipts from fees, sales, rentals,
tolls, maintenance assessments, and other charges for commodities or services.
Exclude utility receipts (Reported in item 1 above) and amounts received from other
governments (Reported in Part 3).
A. Sewerage charges……………………………………………………….
B. Refuse collection and disposal charges………………………..………
C. Recreation charges (swimming, golf, auditoriums, etc.)……….…..…
A80
$
,
,
.0 0
$
,
,
.0 0
$
,
,
.0 0
$
,
,
.0 0
$
,
,
.0 0
$
,
,
.0 0
$
,
,
.0 0
$
,
,
.0 0
$
,
,
.0 0
A81
A61
A01
D. Airports……………………………………………………………………...
Include rentals and gross sales of gas and oil.
A36
E. Hospital charges………………………………………………………….
Other Revenues
Include amounts received on behalf of individual patients under the
Medicare program or other insurance-type arrangements.
Exclude Medicaid and the amounts for hospital purposes received
from other governments (Reported in Part 3).
A60
F. Parking facilities (lots, garages, meters, etc).…………………………..
A50
G. Housing project rentals (gross)……………………………………..……
H. Toll highways and other roads…………………………………………...
Include bridges, tunnels, and ferries
A44
A87
I. Sea and inland port facilities……………………………………………...
Please continue on the next page
1/26
Page 7
..Part 4.. REVENUES - OTHER THAN TAX AND INTERGOVERNMENTAL REVENUES
CONTINUED
2. Other sales and service revenue – cont’d
J.
Other Revenues
Education
A09
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
3. Special assessments - Compulsory contributions and reimbursements from
owners of property benefited by improvements (streets, sewers, sidewalks,
U01
water extensions, etc.), as well as for servicing special assessment debt…….…. $
,
,
.00
$
,
,
.00
5. Interest earnings - Interest received on all deposits and investment holdings U20
$
of your government and its agencies…………………….…………………………..
,
,
.00
$
,
,
.0 0
$
,
,
.0 0
8. Private donations - Gifts of cash or securities from private individuals or
U50
corporations……………………………………………………………………………..
$
,
,
.0 0
(1) K-12: Gross receipts from sale of school lunches………..………
A10
(2) K-12: School tuition……………………………………..…………..
A12
(3) K-12: Other school receipts…………………………..…………….
A18
(4) Higher education charges…………………………….…………….
A89
K. Other sales and service revenues, specify:………………………………….
Include miscellaneous fee collections.
Exclude proceeds from sales of special assessment bonds (Reported in Part 9)
and maintenance assessments (Reported in item 2 above).
U11
4. Receipts from sale of property and other capital assets…..…………………
Include property sold to other governments.
Exclude tax sales (Reported in Part 2).
Include interest on construction funds.
Exclude earnings of any employee pension fund.
6. Fines and forfeits - Receipts from penalties imposed for violations of law
and civil penalties……………………………………………………………………...
7. Rents and royalties - Revenue from temporary possession or use of
government-owned buildings, land, and other properties………………………...
Please continue on the next page
U30
U40
U40
1/26
Page 8
..Part 4.. REVENUES - OTHER THAN TAX AND INTERGOVERNMENTAL REVENUES
CONTINUED
9. Miscellaneous other revenues - Revenues of your government and its agencies
not reported in items 1 through 8, or Parts 2 - 3).
Include insurance claims, recoveries of prior year expenditures, dividends, and
recorded profits from sale of investments.
U99
Exclude proceeds from borrowing, receipts from sale of security holdings, transfers
between funds or accounts of your government, employee’s contributions to, and
interest earnings of, any employee pension fund.
Specify and report miscellaneous revenue:
???
A.
……………………………….
U99
B.
………………………………..
U99
C.
………………………………..
U99
D.
………………………………..
E.
………………………………..
U99
Other Revenues
$
,
,
.0 0
$
,
,
.0 0
$
,
,
.0 0
$
,
,
.0 0
$
,
,
.00
U99
Total Revenues
REV
..Part 5.. TOTAL REVENUES (sum of Parts 2 - 4)………………………
Please continue on the next page
$
,
,
.00
1/26
Page 9
..Part 6. INTERGOVERNMENTAL EXPENDITURES
Report all payments made to other governments for services or programs performed on a reimbursement
or cost-sharing basis.
1. Highways
2. Financial administration
3. Central administration
4. Fire protection
5. Parks and recreation
6. Solid waste management
7. Sewerage
8. Water supply
9. Hospitals
10. Health (other than hospitals)
M44
$
,
,
.00
M23
$
,
,
.00
M29
$
,
,
M24
$
,
M61
$
M81
L44
$
,
,
.00
L23
$
,
,
.00
.00
L29
$
,
,
.00
,
.00
L24
$
,
,
.00
,
,
.00
L61
$
,
,
.00
$
,
,
.00
L81
$
,
,
.00
M80
$
,
,
.00
L80
$
,
,
.00
M91
$
,
,
.00
L91
$
,
,
.00
M36
$
,
,
.00
L36
$
,
,
.00
M32
$
,
,
.00
L32
$
,
,
.00
Please continue on the next page
1/26
Page 10
..Part 6. INTERGOVERNMENTAL EXPENDITURES
CONTINUED
11. Police protection
12. Judicial and legal services
13. Correctional institutions
14. Other correctional activities
15. Libraries
16. Public welfare
17. Protective inspection
18. Housing and community
development
19. Natural resources
M62
$
,
,
.00
M25
$
,
,
.00
M04
$
,
,
M05
$
,
M52
$
M79
L62
$
,
,
.00
L25
$
,
,
.00
.00
L04
$
,
,
.00
,
.00
L05
$
,
,
.00
,
,
.00
L52
$
,
,
.00
$
,
,
.00
L79
$
,
,
.00
M66
$
,
,
.00
L66
$
,
,
.00
M50
$
,
,
.00
L50
$
,
,
.00
M59
$
,
,
.00
L59
$
,
,
.00
Please continue on the next page
1/26
Page 11
..Part 6. INTERGOVERNMENTAL EXPENDITURES
20. Airports
21. Electric supply
22. Parking
23. Natural gas supply
24. Transit
25. Sea and inland port facilities
26. Education
(elementary, secondary)
27. Education (post-secondary)
M01
$
,
,
.00
L01
$
,
,
.00
M92
$
,
,
.00
L92
$
,
,
.00
M60
$
,
,
.00
L60
$
,
,
.00
M93
$
,
,
.00
L93
$
,
,
.00
M94
$
,
,
.00
L94
$
,
,
.00
M87
$
,
,
.00
L87
$
,
,
.00
M12
$
,
,
.00
L12
$
,
,
.00
M18
$
,
,
.00
L18
$
,
,
.00
M89
$
,
,
.00
L89
$
,
,
.00
28. Other, specify:
Check here if your government made no payments to other governments during the fiscal year reported
in Part 1.
Please continue on the next page
1/26
..Part 7.
DIRECT EXPENDITURES BY PURPOSE AND TYPE
Page 12
Report amounts expended during the fiscal year indicated in .Part 1.
Include expenditures of all funds except those noted in any separate instructions included with this form.
Exclude:
• Transfers between funds or accounts of your government
• Payments made to other governments (Reported in .Part 6.).
Current Operation
Direct expenditures for
employee compensation
and for supplies,
materials, operating
leases, and contractual
services.
Capital Outlays
Purchase of equipment,
land and existing
structures
Include gross salaries and
wages before deductions.
Exclude capital outlays and
depreciation/amortization
1. Toll highways - maintenance,
E45
$
operation, repair, and construction of
highways, roads, bridges, ferries, and
tunnels operated on a fee or toll basis.
2. Highways - Construction and
maintenance of roads, sidewalks
and bridges; street lighting; snow
removal; highway engineering,
control, and safety.
Include capital leases
Construction
,
,
.00
F45
$
,
,
.00
G45
$
,
,
.00
E44
$
,
,
.00
F44
$
,
,
.00
G44
$
,
,
.00
E23
$
,
,
.00
F23
$
,
,
.00
G23
$
,
,
.00
E29
$
,
,
.00
$
,
,
.00
G29
$
,
,
.00
Exclude street cleaning
expenditures (Report in item 7).
3. Financial administration - office
of the finance director, auditor,
comptroller, treasurer; tax
assessment and collection; central
accounting and purchasing services,
budgeting, etc.
4. Central administration - county
or city council, aldermen or
commissioners; county, city or town
administrator or manager; clerks
office, recorder, planning, zoning
and personnel.
F29
Please continue on the next page
1/26
Part 7.
Page 13
DIRECT EXPENDITURES BY PURPOSE AND TYPE
CONTINUED
Current Operation
Capital Outlays
Direct expenditures
including salaries and
wages
5. Fire - firefighting and fire
prevention.
Purchase of equipment,
land and existing
structures
Construction
E24
$
,
,
.00
F24
$
,
,
.00
G24
$
,
,
.00
E61
$
,
,
.00
F61
$
,
,
.00
G61
$
,
,
.00
E81
$
,
,
.00
F81
$
,
,
.00
G81
$
,
,
.00
E80
$
,
,
.00
F80
$
,
,
.00
G80
$
,
,
.00
E91
$
,
,
.00
F91
$
,
,
.00
G91
$
,
,
.00
Include ambulance and paramedic
services handled by the fire
department and contributions to
volunteer fire units.
Exclude any contributions to a local
fire pension fund and forest fire
protection amounts (Report in item
21).
6. Parks and other recreation playgrounds; golf courses; swimming
pools; museums; marinas; community
music, drama, festivals; zoos, and
other cultural activities.
7. Solid waste management street cleaning and the collection,
recycling and disposal of refuse and
garbage.
8. Sewerage - construction,
maintenance and operation of
sanitary and storm sewer systems
and sewage disposal plants.
9. Water supply system
Please continue on the next page
1/26
Page 14
Part 7.
DIRECT EXPENDITURES BY PURPOSE AND TYPE
CONTINUED
Current Operation
Capital Outlays
Direct expenditures
including salaries and
wages
10. Hospitals - construction and
operation of hospitals by your
government; payments to hospitals
operated privately.
11. Health (other than hospitals) all public health activities except
provision of hospital care.
Purchase of equipment,
land and existing
structures
Construction
E36
$
,
,
.00
F36
$
,
,
.00
G36
$
,
,
.00
E32
$
,
,
.00
F32
$
,
,
.00
G32
$
,
,
.00
E62
$
,
,
.00
F62
$
,
,
.00
G62
$
,
,
.00
E25
$
,
,
.00
F25
$
,
,
.00
G25
$
,
,
.00
Include environmental health
activities; health regulation and
inspection, water and air pollution
control, mosquito control, animal
control warden, inspection of food
handling establishments, and
ambulance and paramedic services
not part of a fire department. Also
include public health nursing, vital
statistics collection, and all other
services performed directly by the
public health department.
Exclude payments under public
welfare programs (Report in item
18).
12. Police - police agencies for
preventing, controlling, or reducing
crime; law enforcement activities or
sheriff and constable offices;
coroners; medical examiners;
vehicular inspection activities; and
traffic control and safety activities;
lock-up operations.
Exclude your contribution to a local
police pension fund; local court
activities (Report in item 13), and
local correction activities (Report in
items 14 and 15).
13. Judicial and legal - all county
or municipal court and court-related
activities including juries, probate
officials, prosecutors, bailiffs,
marshals, public defenders,
attorneys, legal departments, and
court activities of sheriffs
departments.
Exclude probation and parole
(Report in item 15).
Please continue on the next page
1/26
Page 15
Part 7.
DIRECT EXPENDITURES BY PURPOSE AND TYPE
CONTINUED
Current Operation
Capital Outlays
Direct expenditures
including salaries and
wages
14. Correctional institutions construction, maintenance, and operation
of correctional facilities, reformatories,
detention facilities, etc., whether for
adults or juveniles.
Purchase of equipment,
land and existing
structures
Construction
E04
$
,
,
.00
F04
$
,
,
.00
G04
$
,
,
.00
E05
$
,
,
.00
F05
$
,
,
.00
G05
$
,
,
.00
E31
$
,
,
.00
F31
$
,
,
.00
G31
$
,
,
.00
E52
$
,
,
.00
F52
$
,
,
.00
G52
$
,
,
.00
E79
$
,
,
.00
F79
$
,
,
.00
G79
$
,
,
.00
Exclude activities related to probation
and parole (Report in item 15).
15. Other corrections - activities related
to probation and parole, training of
corrections officers, nonresidential
halfway houses, and community
corrections centers.
16. General public buildings construction, maintenance, and operation
of government office buildings not
relating to particular purposes.
Report single-purpose buildings
(firehouses, hospitals, etc.) at the
purpose specified.
17. Libraries - payments to
nongovernmental libraries as well as
expenditures for libraries operated by
your government.
18. Public welfare - support of, and
assistance to, needy persons including
expenditures from State and Federal
grants.
Include:
• Money paid directly to needy persons
covered by Federal aid programs.
• Payments to private vendors for
medical and hospital care provided to
needy persons
• Administration of relief and assistance
• Welfare institutions (including nursing
homes)
• Foster care
• Related community action programs
Exclude any payments to the State for
your government’s share of the welfare
costs (Reported in Part 6).
Please continue on the next page
1/26
Part 7.
Page 16
DIRECT EXPENDITURES BY PURPOSE AND TYPE
CONTINUED
Current Operation
Capital Outlays
Direct expenditures
including salaries and
wages
19. Protective inspection and
regulation - regulation of private
enterprise for the protection of the
public and inspection of hazardous
activities (including building
inspection), except when related to
major functions, such as health,
natural resources, etc.
20. Housing and community
development - gross expenditures
for urban renewal, housing projects,
and similar activities.
21. Natural resources - flood
control, soil and water conservation,
drainage, irrigation, forestry and
forest fire protection, agricultural
fairs, and any other activities for
promotion of agriculture and
conservation of natural resources.
22. Airports
23. Electric power system
24. Parking facilities - garages,
parking lots, and all purchases and
maintenance of meters, etc.
Purchase of equipment,
land and existing
structures
Construction
E66
$
,
,
.00
F66
$
,
,
.00
G66
$
,
,
.00
E50
$
,
,
.00
F50
$
,
,
.00
G50
$
,
,
.00
E59
$
,
,
.00
F59
$
,
,
.00
G59
$
,
,
.00
E01
$
,
,
.00
F01
$
,
,
.00
G01
$
,
,
.00
E92
$
,
,
.00
F92
$
,
,
.00
G92
$
,
,
.00
E60
$
,
,
.00
F60
$
,
,
.00
G60
$
,
,
.00
Please continue on the next page
1/26
Page 17
Part 7.
DIRECT EXPENDITURES BY PURPOSE AND TYPE
CONTINUED
Current Operation
Capital Outlays
Direct expenditures
including salaries and
wages
25. Gas supply system
26. Transit or bus system
27. Sea and inland port facilities docks, wharves, harbors, piers,
canals, waterways and related
warehouses.
28. Miscellaneous commercial
activities - directly operated by your
government such as cemeteries,
cable television, telephone utilities,
rail lines, etc.
Purchase of equipment,
land and existing
structures
Construction
E93
$
,
,
.00
F93
$
,
,
.00
G93
$
,
,
.00
E94
$
,
,
.00
F94
$
,
,
.00
G94
$
,
,
.00
E87
$
,
,
.00
F87
$
,
,
.00
G87
$
,
,
.00
E03
$
,
,
.00
F03
$
,
,
.00
G03
$
,
,
.00
,
,
.00
F12
$
,
,
.00
G12
$
,
,
.00
,
,
.00
29. Education - if your government
E12
$
does not directly administer schools,
report any expenditures for school
purposes. If your government does
directly administer schools, please see
any separate instructions for your
state.
Exclude payments to local school
districts (Reported in Part 6).
30. Interest on debt - amounts of
interest paid, including any interest
on short-term or non-guaranteed
obligations as well as general
obligations.
I89
$
Include capitalized interest paid on
construction loans.
Please continue on the next page
1/26
Page 18
Part 7.
DIRECT EXPENDITURES BY PURPOSE AND TYPE
CONTINUED
31. All other expenditures - any amounts which have not been allocated above by purpose.
Include:
•
•
•
Exclude:
•
•
•
•
Your employer contribution to a state administered retirement system or to Federal Social Security
Judgments and insurance premiums
Government service agencies, such as a central garage or an IT or engineering department which serves more
than one functional agency, and whose expenses are not allocated to the various departments
Payments for retirement of debt
Payments for purchase of securities
Transfers between funds or agencies of your government
Benefits and payments from self-administered employee pension funds
Current Operation
Other - Specify
Capital Outlays
Direct expenditures
including salaries and
wages
Purchase of equipment,
land and existing
structures
Construction
A.
E_ _
$
,
,
.00
F_ _
$
,
,
.00
G_ _
$
,
,
.00
B.
E_ _
$
,
,
.00
F_ _
$
,
,
.00
G_ _
$
,
,
.00
C.
E_ _
$
,
,
.00
F_ _
$
,
,
.00
G_ _
$
,
,
.00
D.
E_ _
$
,
,
.00
F_ _
$
,
,
.00
G_ _
$
,
,
.00
E.
E_ _
$
,
,
.00
F_ _
$
,
,
.00
G_ _
$
,
,
.00
F.
E_ _
$
,
,
.00
F_ _
$
,
,
.00
G_ _
$
,
,
.00
Total Expenditures
..Part 8.. TOTAL EXPENDITURES (sum of ..Parts 6 - 7.)…………… $
Please continue on the next page
,
,
.00
1/26
Page 19
..Part 9.. INDEBTEDNESS
..Long-term Debt...........................................................................................................................................................
Bonds, mortgages, etc., with an original term of more than one year, including revenue bonds and special
assessment bonds as well as general obligations.
Include debt refunded.
Exclude:
• capital leases (Reported in .Part 7.)
• amounts for compensated absences
Long-term Debt
for Public Purposes
1. What is your government’s debt for all public purposes?
19X
,
,
.00
$
,
,
.00
39X
C. Retired during fiscal year (include debt refunded).........................…......…. - $
,
,
.00
49X
,
,
.00
A. Outstanding at beginning of fiscal year..............................................…...
B. Issued during fiscal year (include all refunding issues)..........................….
+ $
29X
+
D. Outstanding total at end of fiscal year (Item A + B - C).....................…..... = $
2. What is your government’s debt for privately owned housing, industrial,
or business purposes? This category is applicable only to those governments
authorized to issue debt of this type (e.g., industrial development revenue bonds,
pollution control revenue bonds, etc.)
19T
A. Outstanding at beginning of fiscal year.............................................…...
+
29T
B. Issued during fiscal year (include all refunding issues)....…................…… +
39T
C. Retired during fiscal year (include debt refunded)......………................….. 49T
D. Outstanding total at end of fiscal year (Item A + B - C)............…………… =
Long-Term Debt
for Private Purposes
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
..Short-term (interest-bearing) Debt...........................................................................................................................
Tax-anticipation notes, bond-anticipation notes, interest-bearing warrants, and other obligations with an
original term of one year or less.
Exclude accounts payable, other non-interest-bearing obligations, and current
portion of long-term debt (Reported as long-term debt above).
Short-term Debt
61V
3. Amount outstanding at beginning of fiscal year..............................................
$
,
,
.00
$
,
,
.00
64V
4. Amount outstanding at end of fiscal year........................................................
Please continue on the next page
1/26
Page 20
.Part 10.. CASH AND INVESTMENTS HELD AT END OF FISCAL YEAR
Report cash and investments held at the end of the fiscal year indicated in .Part 1, including:
•
•
The total amount of cash and cash equivalents on hand and on deposit
Investments in Federal government, Federal agency, State and local government and
non-governmental securities.
Report all investments at market value.
Exclude accounts receivable, value of real property, and all non-security assets.
Amount at end of fiscal year
1. Reserves held for redemption of long-term debt (e.g. sinking or debt service W01
,
,
.00
funds).………………………………………………………………………………………. $
Include any mortgages and notes receivable held as offsets
to housing and industrial financing loans.
2. Unexpended proceeds from sale of bond issues held pending disbursementW31
$
(e.g. bond funds)………………………………………………………………………….
3. All other cash and investments – checking/savings accounts, CD’s, stocks,
bonds, mutual funds, etc……………….……………………………..…………………
W61
$
,
,
.00
,
,
.00
Exclude employee retirement funds.
..Part 11..
..Part 12
REMARKS
CERTIFICATION
This report is substantially accurate and had been prepared in accordance with the instructions.
Name of person completing report – Please print
Title of person completing report
Telephone Number
Area Code
Number
Date form was completed
Email Address
Extension
Thank you for your report. Please return to:
U.S. Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001
This form has been approved by the Office of Management and Budget (OMB) and has been given the number 0607-0585. Please note that we have
displayed this number in the upper right hand corner of this form. Display of this number confirms that we have approval from OMB to conduct this
survey. If this number were not displayed, we could not request your participation in this survey.
Please note that this is a national form that applies to governments with wide differences in the size of their service areas, the amount of the population
served, and the extent and complexity of their financial account. We estimate public reporting burden for this collection of information to vary from 2.0
to 8.0 hours per response, with an average of 3.0 hours per response, including time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate
or any other aspect of this collection of information, including suggestions for reducing this burden, to: Paperwork Project 0607-0585, U.S. Census
Bureau, 4700 Silver Hill Road, Stop 1500, Washington, D.C. 20233-1500. You may e-mail comments to Paperwork@census.gov; use "Paperwork
Project 0607-0585" as the subject.
1/26
| File Type | application/pdf |
| File Modified | 2005-04-04 |
| File Created | 2005-01-27 |