Various Economic Area Pretesting Activities

11020013
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

2012 Annual Survey of Local Government Finances

U.S. CENSUS BUREAU
(8-4-2010)

Multi - Function Special Agencies

FORM

F-29

(04-05-2011) Draft 1

OMB No. 0607-0585: Approval Expires 06/30/2011
In correspondence pertaining to this report, please refer to the ID printed above your address

RETURN TO:
U.S. Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001

If you have any questions,
please call 1-888-590-2748
weekdays, 7:00 a.m. to
5:00 p.m. EST.

Questions can also be
emailed to:
[email protected]

Please correct any errors in name, address, or ZIP Code.

INTERNET RESPONSE
You may respond to this survey via the Internet at the following web address: http://harvester.census.gov/sgfnet
You will only need your User ID to access the Internet form. Your User ID is the first 14 digits of the 18 digit ID located
on the top line of the address section above.

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 employeeretirement
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.
5. Use a black or blue ball point pen.

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.
2011

2012

July

October

January

April

August

November

February

May

September

December

March

June

Please continue on the next page

USCENSUSBUREAU

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11020047

TAX REVENUES

Part 2

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
1. Property taxes - All taxes on property, real or personal . . . . . . . . . . T01 $
Include levies for debt service, pension funds, and other funds or purposes.
Exclude taxes not measured by value.
..

2. Other taxes - specify:

T99

$

,

,

.00

Other Taxes

,

,

.00

INTERGOVERNMENTAL REVENUES

Part 3

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. If your agency received payments under the American Recovery
and Reinvestment Act of 2009 (ARRA), include them in the appropriate categories below.
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, streets and highways, sewerage, transit, health
and hospitals, etc).
From the State - Include any
From other local governments

amounts financed wholly or in part from
Federal grants to the State (i.e.,
pass-throughs).
Exclude collection fees.

From the Federal
government directly

A. Purpose - Specify:
Dxx

$

Cxx

1. Streets and highways.00

,

,

$

Bxx

,

,

.00

$

,

,

,

,

,

,

,

,

.00

B. Purpose - Specify:
Dxx

$

Cxx

1. Streets and highways.00

,

,

$

Bxx

,

,

.00

$

.00

C. Purpose - Specify:
Dxx

$

Cxx

1. Streets and highways.00

,

,

$

Bxx

,

,

.00

$

.00

D. Purpose - Specify:
Dxx

$

Cxx

1. Streets and highways.00

,

,

$

Bxx

,

,

.00

$

Please continue on the next page
Form F-29

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11020047

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 Federal, State, or local governments.
Exclude grants and other amounts received from the Federal, State, or other local 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.

..

XXX

$

B.

..

XXX

$

C.

..

XXX

$

D.

..

XXX

$

2. Special assessments - Compulsory contributions and
reimbursements from owners of property benefited by
improvements (streets, sewers, sidewalks, water extensions,
etc.), as well as for servicing special assessment debt . . . . . . . . . . . U01
Exclude proceeds from sales of special assessment bonds (report in
Part 10) and maintenance assessments (reported in item 1 above).

$

$

U20

$

5. Fines and forfeits - Receipts from penalties imposed for
violations of law and civil penalties . . . . . . . . . . . . . . . . . . . . . . . . .

U30

$

6. Royalties - Compensation or portion of proceeds from extraction
of natural resources, such as oil, gas, and mineral rights. . . . . . . . . .

U41

$

7. Private donations - Gifts of cash or securities from private
individuals or corporations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

U50

$

4. Interest earnings - Interest received on all deposits and
investment holdings of your agency, excluding earnings of any
employee pension fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Include interest on construction funds.

8. Miscellaneous other revenue - Revenue not reported in items
1 through 7, or Parts 2 - 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . U99
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 contributions
to, and interest earnings of, any employee pension fund.
Please continue on the next page
Form F-29

3

.00
.00
.00
.00

Other Revenues

U11

3. Receipts from sale of property and other capital assets . . . . . . .
Include property sold to other governments.
Exclude tax sales (reported in Part 2).

,

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.00

.00

.00

.00

.00

.00

.00

11020047

Part 5

TOTAL REVENUES
Total Revenues

Sum of Parts 2 - 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . REV

Part 6

$

,

,

.00

INTERGOVERNMENTAL EXPENDITURES

Specify Purpose - (e.g., water, sewer, natural resources, solid waste, highways, electric generation, parks
and recreation, airports, etc.)

Function - (e.g., water supply,
sewerage, electricity, fire
protection, airports, natural
resources, housing and
community development, solid
waste, etc.). Specify:

Type of
recipient government (e.g., municipality, school
district,county, State, etc.).
Specify:

Amount

▼

▼

A.

XXX

$

B.

XXX

$

C.

XXX

$

D.

XXX

$

,

,

,

,

,

,

,

,

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
Form F-29

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11020047

DIRECT EXPENDITURES BY PURPOSE AND TYPE

Part 7

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:
• Transfer between funds or accounts of your government.
• Payments made to other governments (reported in Part 6).
Specify Purpose - (e.g., water, sewer, natural resources, solid waste, highways, electric generation, parks
and recreation, airports, etc.)

Current Operation

Capital Outlays

Direct expenditures for employee
compensation and for supplies,
materials, operating leases, and
contractual services.
Include gross salaries and
wages before deductions.
Exclude capital outlays and
depreciation/amortization

Purchase of equipment,
land and existing structures
Include capital leases

Construction

A. Purpose - Specify:
Exx

$

Fxx

1. Streets and highways.00

,

,

$

Gxx

,

,

.00

$

,

,

,

,

,

,

,

,

,

,

.00

B. Purpose - Specify:
Exx

$

Fxx

1. Streets and highways.00

,

,

$

Gxx

,

,

.00

$

.00

C. Purpose - Specify:
Exx

$

Fxx

1. Streets and highways.00

,

,

$

Gxx

,

,

.00

$

.00

D. Purpose - Specify:
Exx

$

Fxx

1. Streets and highways.00

,

,

$

Gxx

,

,

.00

$

.00

E. Purpose - Specify:
Exx

$

Fxx

1. Streets and highways.00

,

,

$

Gxx

,

,

.00

$

Please continue on the next page
Form F-29

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11020047

Part 7

DIRECT EXPENDITURES BY PURPOSE AND TYPE - Continued

Interest on Debt
1. Report the total amount of interest paid on debt, long-term and short-term, of your agency.
Include capitalized interest paid on construction loans.
Exclude debt retirement (report in Part 10).
Interest Expenditures
Long-term Debt
for Public
Purposes
,
,

A. Interest on water supply system debt . . . . . . . . . . . . . . . . . . . .

I91

$

B. Interest on electric power system debt . . . . . . . . . . . . . . . . . . .

I92

$

Long-term Debt
for Public
Purposes
,
,

.00

C. Interest on gas system debt. . . . . . . . . . . . . . . . . . . . . . . . . . .

I93

$

Long-term Debt
for Public
Purposes
,
,

.00

D. Interest on transit or bus system debt. . . . . . . . . . . . . . . . . . . .

I94

$

Long-term Debt
for Public
Purposes
,
,

.00

E. Interest on all other debt. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I89

$

Long-term Debt
for Public
Purposes
,
,

.00

Part 8

TOTAL EXPENDITURES

Sum of Parts 6 - 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part 9

EXP

$

Total Expenditures
Long-term Debt
for Public
Purposes
,
,

.00

.00

PERSONNEL EXPENDITURES

Report total expenditures for salaries and wages reported
in Part 7 including any paid to employees of your agency
working on construction projects . . . . . . . . . . . . . . . . . . . . . . . . . .

Z00

$

Personnel Expenditures
Long-term Debt
.00
for Public
Purposes
,
,

Please continue on the next page
Form F-29

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11020047

Part 10

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 obligation bonds.
Include debt refunded.
Exclude
• Capital leases (reported in Part 7).
• Amounts for compensated absences
1. What is your agency’s debt for all public purposes?
19U

A. Outstanding at beginning of fiscal year . . . . . . . . . . . . . . . . +
29U

B. Issued during fiscal year (include all refunding issues). . . . . . +
39U

C. Retired during fiscal year (include debt refunded) . . . . . . . . . 49U

D. Outstanding total at end of fiscal year (items 1A + 1B - 1C) . =

$

19T

Outstanding at beginning of fiscal year. . . . . . . . . . . . . . . . +

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 (items 2A + 2B - 2C). =

24T

34T

44T

.00

$

Long-term Debt
for Public
Purposes
,
,

.00

$

Long-term Debt
for Public
Purposes
,
,

.00

$

Long-term Debt
for Public
Purposes
,
,

.00

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.)
A.

Long-term Debt
for Public Purposes
Long-term Debt
for Public
Purposes
,
,

$

Long-term Debt
for Private Purposes
Long-term Debt
for Public
Purposes
,
,

.00

$

Long-term Debt
for Public
Purposes
,
,

.00

$

Long-term Debt
for Public
Purposes
,
,

.00

$

Long-term Debt
for Public
Purposes
,
,

.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
Long-term Debt
for Public
Purposes
3. Amount outstanding at beginning of fiscal year. . . . . . . . . . . . . 61V $
,
,
4. Amount outstanding at end of fiscal year. . . . . . . . . . . . . . . . . .

64V

$

Long-term Debt
for Public
Purposes
,
,

Please continue on the next page
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11020047

Part 11

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.
1. Reserves held for redemption of long-term debt (e.g.,
sinking or debt service funds) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Include any mortgages and notes receivable held as offsets
to housing and industrial financing loans

Amount at end
of fiscal year
Long-term Debt
for Public
Purposes
,
,

W01

$

.00

2. Unexpended proceeds from sale of bond issues held
pending disbursement (e.g., bond funds). . . . . . . . . . . . . . . . . . .

W31

$

Long-term Debt
for Public
Purposes
,
,

.00

3. All other cash and investments - checking/savings accounts,
CD’s, stocks, bonds, mutual funds, etc. . . . . . . . . . . . . . . . . . . . . .

W61

$

Long-term Debt
for Public
Purposes
,
,

.00

Exclude employee retirement funds.

Part 12

REMARKS

Part 13

CERTIFICATION

This report is substantially accurate and has been prepared in accordance with the instructions.
Name of person completing report - Please print

Title of person completing report - Please print

Date form was completed

Telephone Number
Area Code

Number

E-mail Address - Please print

Ext.

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 was 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 size of their service areas, the amount of
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, 4600 Silver Hill Road, AMSD-3K138, Washington, D.C. 20233. You may
e-mail comments to [email protected]; use "Paperwork Project 0607-0585" as the subject.

Census Use Only

BEG

REV

EXP

REP

DIFF

V98

Form F-29

8

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