N.Y. Comp. Codes R. & Regs. tit. 2, Appendices, app 9
Form A. C. 972 (1963 Rev.)
School Districts outside Cities
DEBT STATEMENT
OF
________
in the ________ of ________
________
________ COUNTY, NEW YORK
PREPARED AS OF
________, 19________
Form A.C.972-1
School Districts outside Cities
INSTRUCTIONS
1. WHEN FILING IS REQUIRED. A debt statement must be filed not more than fifteen days nor less than three days before any school district having an aggregate assessed valuation of real property of $100,000 or over sells any bonds which are required to be sold at public sale. Local Finance Law, Section 109.00(a).
2. DATE OF PREPARATION. The statement must be prepared as of a date not more than thirty days previous to the date of sale of the bonds. Local Finance Law. Section 109.00(a).
3. PLACE OF FILING. The statement must be filed with the State Comptroller. To insure prompt delivery to the correct filing office, address envelope as follows: 'Department of Audit and Control, Division of Municipal Affairs, 110 State Street, Albany, New York 12236-0001'. A duplicate copy must be filed with the clerk (or corresponding officer) of the school district. Local Finance Law Section 109.00(a).
4. VERIFICATION. The statement must be verified by the chief fiscal officer of the school district. In school districts, the chairman or president of the school board is the chief fiscal officer. In the case of common school districts having a sole trustee, the sole trustee is the chief fiscal officer.
5. BOND ANTICIPATION NOTES.
(a) In connection with the sale of bond anticipation notes, a school district may prepare a debt statement and may file such statement in the manner provided in Section 309.00 of the Local Finance Law. Local Finance Law, Section 137.00 (last sentence). In such case enter the amount of such notes at Part 3 of Section A on Page 2.
(b) Where bonds are being sold, do not include in Part 1, 2, 3, 4 or 5 of Section A the amount of bond anticipation notes issued, or proposed to be issued, in anticipation of the bonds proposed to be sold, the amount of which bonds is entered at Part 2 of Section A. This will result in a double inclusion of indebtedness.
6. ESTIMATE OF STATE AID APPORTIONMENT. A school district which completes paragraph 1 of Section C of this statement may obtain three certified copies of the estimate of the Commissioner of Education, referred to in such section, from the State Department of Education without charge. A certified copy of the estimate must be attached to each of the copies which are filed in accordance with Instruction 3 above. Section 121.20 of the Local Finance Law provides that the estimate is effective only until June 30 next succeeding the date thereof.
7. FEES FOR COPIES. Should it be necessary to obtain a copy, certified copy or exemplified copy of a debt statement filed with the State Comptroller, the same may be obtained upon prepayment of the following fees: (Local Finance Law, Section 141.00(c)).
1. Copy (not certified) ............ $1.50
2. Certified copy where copy is presented for certification............ 1.50
3. Certified copy where copy is not presented for certification ............ 2.00
4. Exemplified copy where copy is presented for exemplification ............ 2.50
5. Exemplified copy where copy is not presented for exemplification ............ 3.00
An additional fee of 10¢ per folio is charged where entries in Parts 1 and 2 of Schedule A at Page 4 exceed ten folios. Make check payable to 'State Comptroller'.
Form A. C. 972-2
1. Outstanding Bonds and Bond Anticipation Notes
Outstanding bonds ............ $ ________
Outstanding bond anticipation notes ............ ________
(Do not include notes issued in anticipation of the bonds
at Part 2 below. See Instruction 5)
2. Bonds of the Proposed Bond Issue in Connection with which
this Debt Statement is Prepared
Bonds proposed to be sold ............ ________
3. Bond Anticipation Notes of the Proposed Note Issue in
Connection with which this Debt Statement is Prepared
Bond anticipation notes proposed to be sold ............ ________
(Do not include notes issued, or proposed to be issued,
in anticipation of bonds at Part 2 above, See Instruction 5)
4. Bonded Indebtedness of a Merged or Annexed School District
(a) Enter the amount of outstanding bonds and bond antici-
pation notes ofschool districts which merged to form the
reporting school district, whether or not any of such
other school districts prior to such merger, had an aggre-
gate assessed valuation of $100,000 or more and whether
or not any of such other school districts still exist for
the purpose of paying off its indebtedness or distributing
its property ............ ________
(b) Enter the amount of outstanding bonds and bond antici-
pation notes of any school district which was annexed to
the reporting school district, whether or not such annexed
school district had an aggregate assessed valuation of
$100,000 or more, prior to such annexation, and whether
or not it still exists for the purpose of paying off its
indebtedness or distributing its property ............ ________
(c) Enter the appropriate proportion of the amount of out-
standing bonds and bond anticipation notes of any school
district part of which was annexed to the reporting school
district, whether or not the aggregate assessed valua-
tion of such partially annexed school district, prior to
such annexation, was $100,000 or more. The proportion of
the amount of such outstanding bonds and bond anticipa-
tion notes to be so included shall be ascertained by multi-
plying the amount of such bonds and bond anticipation notes by the percentage or ratio, at the time of annexa-
tion, that the average assessed valuation of the portion
of the school district annexed bore to the average
assessed valuation of the whole of such partially
annexed school district as it existed prior to such
annexation ............ ________
(See definition of 'average assessed valuation' at subdivision 7 of section 2.00 of the Local Finance Law.)
5. Bonds and Bond Anticipation Notes Issued by a City which
the School District will be Required to Pay Pursuant to Law
Bonds ............ ________
Bond anticipation notes ............ ________
(Do not include notes issued in anticipation of bonds at
Part 2 above. See Instruction 5)
Total ............ $ ________
________
1. The amount of indebtedness evidenced by bonds and bond
anticipation notes, included in Section A, contracted or
to be contracted for objects or purposes having periods
of probable usefulness provided in subdivisions 11, 12
and 13 of paragraph a of section 11.00 of the Local
Finance Law and in relation to which the Commissioner
of Education has estimated pursuant to section 121.20 of
such law that moneys receivable by the school district
from the State of New York as an apportionment of state
aid for debt service for school building purposes will
meet the interest on and the annual requirements for the
payment of such indebtedness, is ............ $ ________
(A) certified copy of such estimate is attached to and
forms a part of this debt statement. (See Instruction 6)).
2. Indebtedness contracted to finance acquisition, construction, and installation of a shelter or fallout shelter ............ ________
(Maximum amount of exclusion shall not exceed $50.00
multiplied by the planned shelter occupancy. Defense
Emergency Act, Section 29(3)).
Total ............ $________
________
SECTION D. NET INDEBTEDNESS
Bonded Indebtedness (Enter Total of Section A) ............ $________
Less: Exclusions (Enter Total of Section C (1 and 2), if claimed) ............ $________
Total Net Indebtedness ............ $ ________
________
SECTION E. FULL VALUATION OF REAL PROPERTY SUBJECT TO TAXATION BY SCHOOL DISTRICT
SECTION F. BONDED DEBT LIMIT
The bonded debt limit of the school district is ............ $________
(The amount of the limit will be computed by multiplying
the full valuation of real property subject to taxation by
the school district by.10. See Section E).
SECTION G. DEBT-CONTRACTING MARGIN
Debt Limit (Enter amount of Section F) ............ $ ________
Less: Net Indebtedness (Enter amount of Section D) ............ ________
Net Debt-Contracting Margin ............ $ ________
________
SECTION H. CONSENT TO EXCEED DEBT LIMIT
The Board of Regents has consented to the issuance of the bonds proposed to be issued by consent dated ________.
(If Debt-Contracting Margin is "minus", or if this bond issue will produce a "minus" margin, such consent must be obtained. Local Finance Law, Section 104.00(d)).
Form A. C. 972-5
VERIFICATION BY CHIEF FISCAL OFFICER
State of New York)
) ss:
County of ________)
________, being duly sworn, deposes and says: That he is the duly (elected) (appointed), qualified, and acting chief fiscal officer of ________, in the (Town) (Towns) (City) of ________ in the (County) (Counties) of ________, New York; that he prepared and has read the foregoing debt statement and knows the contents thereof, that the same is true to (his) (her) own knowledge except as to the matters therein stated to be alleged upon information and belief, and that as to those matters, he believes it to be true.
Subscribed and sworn to before me this ________
________ day of ________, 19 ________. Title ________
____________
Notary Public Mail Address ________
N.Y. Comp. Codes R. & Regs. tit. 2, Appendices, app 9