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pdfF-29 (2004)
OMB No. 0607-0585: Approval Expires 03/31/2005
2004 Annual Survey of Local Government Finances
Multi - Function Special Agencies
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 be emailed to:
[email protected]
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 agency except for any employee-retirement
funds administered by your agency. 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
agency.
2. As this form is used for various kinds of agencies, some of the items may not apply to your agency. However,
read carefully the definition of each item to determine whether it applies to any of your agency’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 agency’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
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Page 2
..Part 2..
TAX REVENUES
Report collections during the fiscal year indicated in Part 1 from all taxes imposed
by your agency.
Include:
•
•
Taxes collected for your agency by another government.
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.
Property Taxes
T01
,
$
1. Property taxes – All taxes on property, real or personal……………………………
,
.00
Include levies for debt service, pension funds, and other funds or purposes.
Exclude taxes not measured by value.
2. Other taxes – specify
Other Taxes
T99
............................................................................................………
..Part 3..
,
$
,
.00
INTERGOVERNMENTAL REVENUES
Report all amounts received by your agency 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, taxes imposed by your agency which were collected for it by another government (Reported in
Part 2), and receipts from utility sales to other governments (Report in Part 4 ).
Specify and report revenue
by purpose: (e.g., water supply,
From other local
governments
streets and highways, sewerage,
transit, health and hospitals, etc).
A.
D_ _
B.
D_ _
C.
D_ _
D.
From the State –Include
any amounts financed wholly or
in part from Federal grants to the
State (i.e., pass-throughs).
Exclude collection fees.
C_ _
$
,
,
.0 0
$
,
,
.0 0
$
,
,
.0 0
$
,
,
.0 0
D_ _
C_ _
B_ _
$
,
,
.0 0
$
,
,
.0 0
$
,
,
.0 0
$
,
,
.0 0
C_ _
C_ _
Please continue on the next page
From the Federal
government directly
B_ _
$
,
,
.0 0
$
,
,
.0 0
$
,
,
.0 0
$
,
,
.0 0
B_ _
B_ _
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Page 3
..Part 4..
REVENUES - OTHER THAN TAX AND INTERGOVERNMENTAL REVENUES
Report other revenues received by your agency during the fiscal year indicated in Part 1.
Include revenues of all funds.
Exclude refunds and transfers between funds and accounts of your agency.
1. Current charges – Gross receipts from fees, sales, rentals, tolls, maintenance
assessments and other charges for commodities or services.
Include utility services, including sales to the local, State or the Federal governments.
Exclude grants and other amounts received from local, State or the Federal
governments (Reported in Part 3).
Specify and report revenue by type of current charges:
(e.g., water supply, sewerage, solid waste, electric supply, parks and recreation,
natural resources, airports, etc).
Current Charges
A_ _
A.
…………….
B.
.…………….
C.
…………….
D.
…………….
$
,
,
.0 0
$
,
,
.0 0
$
,
,
.0 0
$
,
,
.0 0
A_ _
A_ _
A_ _
2. 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……..….
Other Revenues
,
,
.0 0
$
,
,
.00
4. Interest earnings - Interest received on all deposits and investment holdings U20
of your agency, excluding earnings of any employee pension fund……………….. $
,
,
.0 0
,
,
.0 0
Exclude proceeds from sales of special assessment bonds (Report in Part 9)
and maintenance assessments (Reported in item 1 above).
U11
3. 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.
U30
5. Fines and forfeits - Receipts from penalties imposed for violations of
$
law and civil penalties.............................................................................…............
Please continue on the next page
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Page 4
..Part 4..
REVENUES - OTHER THAN TAX AND INTERGOVERNMENTAL REVENUES
continued
Other Revenues
6. Rents and royalties - Revenue from temporary possession or use of
U40
government-owned buildings, land, and other properties…………………………..
$
,
,
.00
U50
7. Private donations - Gifts of cash or securities from private individuals or
$
corporations…....................................................................................................….
,
,
.00
U99
8. Miscellaneous other revenue - Revenue not reported in items 1 through 7,
or Parts 2 - 3.…………………………………………………………………………….… $
,
,
.00
+
Include insurance claims, recoveries of prior year expenditures, dividends, and
recorded profits from sale of investments.
Exclude proceeds from borrowing, receipts from sale of security holdings, transfers
between funds or accounts of your agency, employee’s contributions to, and interest
earnings of, any employee pension fund.
Total Revenues
REV
..Part 5..
TOTAL REVENUES (sum of Parts 2 - 4)………………..…
$
,
,
.00
U99
???
Please continue on the next page
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Page 5
..Part 6..
INTERGOVERNMENTAL EXPENDITURES
Report all payments made to other governments for services or programs performed on a reimbursement
or cost-sharing basis.
Function – specify:
(e.g., water supply, sewerage,
electricity, fire protection, airports,
natural resources, housing and
community development and solid
waste, etc).
Type of recipient government –
specify:
(e.g., municipality, school district,
county, State, etc).
Amount
___
A.
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
___
B.
___
C.
___
D.
Check here if your agency made no payments to other governments during the fiscal year indicated
in Part 1.
Please continue on the next page
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Page 6
..Part 7. DIRECT EXPENDITURES BY PURPOSE AND TYPE
Types of Expenditures
.
1. Report amounts expended during the fiscal year indicated in .Part 1.
Include expenditures of all funds other than employee-retirement funds administered by your agency.
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.
Purpose – specify
Capital Outlays
Include gross salaries and wages
Purchase of equipment,
land and existing
structures
(e.g., water, sewer, natural
before deductions.
resources, solid waste, highways,
Exclude capital outlays and
electric generation, parks and
depreciation/amortization
recreation, airports, etc.)
Construction
Include capital leases.
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
Interest on Debt
.
I89
2. Report the total amount of interest paid on all debt, long-term and
short-term, of your agency……………………………………………………………
$
,
,
.00
Include capitalized interest paid on construction loans.
Exclude debt retirement (Report in Part 9 ).
Total Expenditures
EXP
..Part 8. TOTAL EXPENDITURES (sum of .Parts 6 - 7 )………………….……..
Please continue on the next page
$
,
,
.00
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Page 7
..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 agency’s debt for all public purposes?
A. Outstanding at beginning of fiscal year..............................................…...
19X
,
,
.00
,
,
.00
39X
,
,
.00
49X
,
,
.00
+ $
29X
B. Issued during fiscal year (include all refunding issues)..........................…. + $
C. Retired during fiscal year (include debt refunded).........................…......…. - $
D. Outstanding total at end of fiscal year (Item A + B - C).....................…..... = $
2. What is your agency’s debt for privately owned housing, industrial,
or business purposes? This category is applicable only to those agencies
authorized to issue debt of this type (e.g., industrial development revenue bonds,
pollution control revenue bonds, etc.)
Long-Term Debt
for Private Purposes
19T
A. Outstanding at beginning of fiscal year.............................................…...
+ $
,
,
.00
29T
$
,
,
.00
$
,
,
.00
$
,
,
.00
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)............…………… =
..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
$
,
,
.00
4. Amount outstanding at end of fiscal year........................................................ $
,
,
.00
3. Amount outstanding at beginning of fiscal year..............................................
64V
Please continue on the next page
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Page 8
.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 [email protected]; use "Paperwork
Project 0607-0585" as the subject.
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| File Type | application/pdf |
| File Modified | 2005-04-04 |
| File Created | 2005-01-27 |