HomeMy WebLinkAbout2012 HA Exemption from Auditapplication must be personally reviewed and approved by the governing body, Approval is evidenced by one of the following two methods:
If the completed application is going to be submitted electronically using email or fax, the application MUST include a resolution of the governing body that states the completed application was personally reviewed and approved by a majority of the
(in an open public meeting. The resolution MUST include the signatures of a majority of the governing body {see sample reso lution).
If the completed application is going to be submitted through postal mail (U,S. Post Office, UPS, FedFx), the application must include the original ink signatures of a majority of the governing body,
ONLY ONE OF THE ABOVE METHODS WHEN FILING THE APPLICATION.
mailing address is:
ice of the State Auditor
at Government Audit Division
E. W" Ave„ Suite 555
ver, CO 80203
fax number is: (303) 866-4062
e -mail address is: OSA.LG(#)siatecous
forms are available:
The "short form" should be submitted if both revenues and expenditures are less than or equal to $100,000. A preparerof the short form must be a person skilled in governmental accounting.
The "long form" should be submitted if either revenues or expenditures are greater than $ 100,000 but are less than or equal to $500,000. A preparer of the long form must bean independent accountant with knowledge of governmental
ountioz.
call (303) 866-3338 if you need help completi the Application for Exemption from Audit forms.
APPLICATION FOR EXEMPTION FROM AUDIT - LQNG FORM - FOR GOVERNMENTS WITH REVENUE OR EXPENDITURES GREATER THAN
$100,000 BUT NOT MORE THAN $600,000
either revenues or expenditures are $100,000 or greater, but not more than $600,000, you may use this form. If both revenues and expenditures are loss than $100,000 individually, use the short form application for
temption from audit.
The Audit Law requires that a person Independent of the entity complete the application It revenues or expenditure are at least 5100,000 but not more than $500,000. independent means someone who is separate from
the entity. Please describe above what your relationship Is with the entity. I
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PART 2 - Financial Statements - Operating Statement - Revenues
Governmental Funds
Proprietary/F1 uclant Funds
Total of All Funds
Revenues f Ot her Financi S ources ,,
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Rental Income
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o O Fin Sources (Add R k
Total Revenues and Other Financing Sources (Add
'Total Revenues and Other Financing Sources (Add
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fines 2-26 and 2-31)
'lines 2-26 and 2-31)
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FART 3 - Financial Statements _ Operating Statement - Expenditures
Governmental F
Pro rista /Fid c!M Funds
Fund*
Fund"
Fund* Fund*
Total of All Funds
3.1 lExpenditures
EgMEM
Ex nditures
3.2
General Government
$ -
$ -
General O eratin & Administrative
$ 20
$ °
3-3
Judicial
$
$
Salaries
$
$ "
s -4
Public S afe
Pa roll Taxes
$ _
$ "
3 -5
r
taw Enforcement
$ -
$
Contract Services
$ __ 68 t 182
$ `
3-6
Fire
$
$
Em to ee Benefits
$
$
3-7
Others i
$
$
Insurance
"
3-8
Public Works
Accounting and Legal Fees
$
$
%
3>9
HtqttaL & Streets
$
$
Repair and Maintenance
$ 7 491
$
3.10
Solid Waste
$
$
Su Iles
$ 85
$
3 11
Others l
$
$ °
Utilities
$ 5,238
$
3-12
Contributions to Fire & Police Pension Assoc.
$
$
Contributions to Fire & Police Pension Assoc.
$
$
Health
$
$ .
Others
_ ' 3 : 13
3-14
Culture and Recreation
$
$
$
$
3-15
Captal Outla
$
$
Capital Outia
3 -16
Debt Service
RMEM
Debt Service
3 »17
Prtncl I matches rt
$
$
Print °r I matches pa 4
$
$ '
3-18
Interest
$
$
Interest
$
$
3.19
Bond Issuance Costs
$ -
$ -
Bond Issuance Costs
3-20
1 Developer Repayments matches rt 4
$
$ -
Develo r Re a menu matches Part 4
$
3
Others !
$
$
Other s ai Loss on Sale of Pro
$ 108,229
$ -
3
3
Total Ex nditures (Add fines 3.2 throe h 3 - 22)
$
$
Total Expenditures (Add fines 3 - 2 throw h 3.22)
$ 209,088
$
3.24
Net Interfund Transfers In Out
$ "
$
Net Interfund Transfers In Out
$ -
$ -
3.25
Other
$ .
$
Accrual Basis Reconcilin Ite
3-26
$
$
Depreciation
$
$ -
3 -27
$ -
$
Other Financing Sources from fine 2 -39
$
$
3-28
$
Capital Outia from fine 3-15
$
$
Debt P i 1 at from line 3 -97
$
$
3 29
$
$
.i:
Total Transfers and Other Expenditures (Lines 3 -24
Total Reconciling items (Line 3-28; plus fine 3 -29, less
3-30
lus lines 3 -25 throe n 3 -29
$
$
line 3 -26, less fine 3- 7)
Excess (Deficiency) of Revenues and Other Financing
Sources Over (Under) Expenditures (Line 244 less
Net Increase (Decrease) In Equity (Line 2-32, plus line 3-
3-31
line 3 -23; us lines 3-24 throe h 3 -3t1
$ -
$
24, us fine 3-30, less line 3 -23
$ 184,3#15)
Fund Equity, January 1 from December 31 prior year Fund Equity, January 1 from December 31 prior year
3 -32 report $ $ report $ 1,913,980
Fund Equity, December 31 (Line 3 -31 plus lane 3- Fund Equity, December 31 (Line 3-31 plus line 3- 32) This
3.33 32) This total should be the same as tine 1 -35. $ $ - total should be the same as line 1 °35. $ 1,729,675 $
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Please complete the following debt schedule, if applicable:
(please only include principal amounts)
MA
he entity's deposits in an
CRS)? If no, please a)
MOM
M
PART 6 - CAPITAL ASSETS
IM M
entity perrormea an annual inventory of
29-1-606, C,R.S,,? If no, please explain:
Complete the following table for PROPRITARY FUNDS-
I =.
Balance -
beginning of the
Additions
Deletions
Year-End Balance
year
-
$
$
$
$
Balance -
beginning of the
Additions
Deletions
Year-End Balance
year
$
$
$
A-
$
X
I
an "oic nire!'tiremeM
a volunteer firemen's
■
PART 9 - TAX PAYER'S BILL OF cw_
,s the entity in compliance with all the provisions of
PART a ti " , .�!'`. •. :•.' ..., 4 !! t ., !! < ttw •! t ��,I��I'E�lall /J
• INFORMATI
Is this application for a newly formed governmental entity?
'Date of formation:
NO
!
, Has the entity changed its name in the , w.
Pl list _ NEW name + PR ..
J
btyofVVh Ridge administrative services
* ms R * R t k "ww «•':
Ry
s pecia l districts p ursuant i® Secti w • 1
^rr e t r`'
Board Member
3 Zachary Urban
Signed Date:
1mv
, attest I am a duty elected or
ipprove the application for exemption from audit,
EST=
Board Member
6
Board Member
7
f Expires�
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