F-25 Annual Survey of Government Finances - State Agencies

F-25 (2004)

OMB No. 0607-0585: Approval Expires 03/31/2005

F-25

In correspondence pertaining to this report, please refer to the
Census File Number above your address.

FORM
(8-2-2004)

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

2004 ANNUAL
SURVEY
OF GOVERNMENT
FINANCES
STATE AGENCIES
RETURN TO

▼

U.S. Census Bureau
ATTN: Governments Division
Washington, DC 20233-6800
State

Office or agency

Data supplied by
Name

Title

Telephone
Number

Area code

(Please correct any error in name, address, and ZIP Code)
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 accounts. 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 [email protected]; use "Paperwork Project 0607-0585" as
the subject.
GENERAL INSTRUCTIONS
Before filling out this form, please read each part carefully.
exclude all transactions of employee-retirement fund(s)
1. If possible, report all figures for the latest 12-month period ended
June 30. If your fiscal year is not on that basis and if you cannot
administered by your agency.
report revenue and expenditure data on that basis, please report
3. For any items which do not apply to your agency, enter "None" or a
such amounts for your latest fiscal year which closed before June
dash (—). However, please report fully for each applicable item.
30, and enter the closing date here —
Month

Day

Year

4. Do not delay reporting to await finally audited figures. Please
supply preliminary figures or estimates, if necessary, to report
promptly; enter an asterisk (*) after any such estimates.

2. Please report consolidated amounts covering all funds and accounts
of your agency, net of any duplicative transfers between funds.
Include amounts of expenditure from bond funds, construction
accounts, and other capital funds, as well as from current funds, but

Part I

5. Please send to us also, a copy of the most recent annual
financial report for your agency. An addressed mailing label
is enclosed for your convenience.
6. If you have any questions, call 1–888–590–2748.

REVENUE — Exclude proceeds from borrowing, sale of investment securities, and any
duplicative transfers between funds and accounts of your agency.
Amount — Omit cents

Item
A. From State funds and agencies — Include any appropriations, reimbursements, or Federal aid received through
State funds.

$

.00

B. Any revenue direct from Federal Government — Exclude loans.

.00

C . Any amounts from counties, cities, and other local governments
C.

.00

D.. From earnings on investments
C

.00

E. From sale of real property

.00

F. Current charges for services
and sales —
Receipts from tolls, rentals, fees,
and other charges for services,
excluding amounts called for
above — Specify major items.

Charges/Revenue

Amount — Omit cents
$

1.

.00

2.

.00

3.

.00

4. All other

.00
Total — Sum of items F1 through F4

G. Other revenue —
Any revenue not covered above.
Exclude proceeds from
borrowing, from sale of security
holdings, and any intra-agency
transfers — Specify major items.

1.

$

$
.00

2.

.00

3.

.00
Total — Sum of items G1 through G3

.00

$

.00

PLEASE RETAIN A COPY OF THE COMPLETED QUESTIONNAIRE FOR YOUR FILES

USCENSUSBUREAU

Page 1, Prints 10% and 100% Black

Part II

EXPENDITURE
Amount — Omit cents

Item

A. Expenditure for construction — Include major repairs, alterations, planning, and design. Include not only
amounts for construction performed on a contract basis, but also any expenditure for construction carried out by
personnel of this agency. Exclude interest capitalized as a cost of construction. Report in item D.

$

.00

B. Purchase of equipment — Include amounts for replacement as well as for additional equipment.

.00

C. Purchase of land and existing structures

.00

D. Interest on debt — Total amount of interest paid on all debt, long-term and short-term, of your agency.
Include capitalized interest paid on construction loans. Exclude debt retirement, which should be reported
in part III, item A3.

.00

E. All other expenditure — All
expenditure other than for
items covered above, including
salaries and wages and
purchases of materials and
supplies for current operation
maintenance. Do not include
(1) payments for purchase of
securities, (2) transfers
between funds and accounts of
your agency, or (3) provision
for depreciation. — Specify
major items.

Expenditures
1.

Amount — Omit cents
$

.00

2.

.00

3.

.00

4.

.00

5.

.00

6. All other

.00

Total — Sum of items E1 through E6

$

.00

F. Salaries and wages included in items A and E above — Total salaries and wages paid during the fiscal year
to all officers and employees of your agency, including regular, temporary, full-time, and part-time personnel.
Also include salaries and wages paid to personnel of this agency working on agency funded construction projects.

Part III

.00

DEBT OUTSTANDING, ISSUED, AND RETIRED

A. Long-term debt — Bonds, mortgages, etc., with an original term of more than one year. General obligation debt comprises
obligations incurred in the name of the agency or the State and bearing its pledge of full faith and credit. It includes special guaranteed
debt obligations payable initially by special funds or revenues, but backed by the credit of the State. Nonguaranteed debt consists of
debt payable solely from earnings or from pledged special assessments or sources.

Amount — Omit cents
Item

General obligation debt

Nonguaranteed debt

(a)

(b)

$

.00 $

.00

2. Issued during fiscal year

.00

.00

3. Retired during fiscal year

.00

.00

4. Outstanding at end of fiscal year (1 plus 2 minus 3)

.00

.00

5. Exhibit of long-term debt
refunding, if any, during the
fiscal year

a. Refunding bonds issued
(included in item 2 above)

.00

.00

b. Long-term debt retired by refunding
(included in item 3 above)

.00

.00

1. Debt outstanding at beginning of fiscal year

B. Short-term (interest-bearing) debt — Bond anticipation notes, bank loans, and other interest-bearing
obligations with a term of one year or less. Exclude accounts payable and any amounts owed to State or
State-agency funds.

Amount — Omit cents

1. Amount outstanding at beginning of fiscal year

$

.00

2. Amount outstanding at end of fiscal year

Part IV

.00

CASH AND INVESTMENTS HELD AT END OF FISCAL YEAR

Report separately for each of the three types of funds listed below, the total amount of cash on hand and on deposit and investments in Federal
Government, Federal agency, State and local government, and non-governmental securities. Report all investments at book value. Include in
the sinking fund total any mortgages and notes receivable held as offsets to housing and industrial financing loans. Exclude accounts
receivable, value of real property, and all non-security assets.

Type of fund

Amount — Omit cents
WØ1

1. Sinking funds — Reserves held for redemption of long-term debt

$

.00

W31

.00

2. Bond funds — Unexpended proceeds from sale of bond issues held pending disbursement
W61

3. All other funds except employee retirement funds
FORM F-25 (8-2-2004)

Page 2, Prints 10% and 100% Black

.00
Page 2