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pdfF-28 (2009)
OMB No. 0607-0585: Approval Expires 06/30/2011
(8-24-2009)
2009 Annual Survey of County, Municipal, and Township
Government Finances
▼
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU
▼
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:
govs.finstaff@census.gov
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 government except for any employee-retirement
funds administered by your government. 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
government.
2. As this form is used for various kinds of governments, some of the items may not apply to your government.
However, read carefully the definition of each item to determine whether it applies to any of your government’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.
ENDING DATE OF FISCAL YEAR
Part 1
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.
2008
2009
July
October
January
April
August
November
February
May
September
December
March
June
▲
F-28 (8-24-2009)
28200901
Please continue on the next page
▲
§=5("¤
Page 2
Part 2
TAX REVENUES
Report collections during the fiscal year indicated in Part 1 from all taxes imposed by your government.
Include 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.
1.
Tax Revenues
Property taxes - All taxes on property, real or personal.
Report collections during the fiscal year from all levies for
$
all funds of your government, and its agencies . . . . . . . . . . . . . . . . . . . . .T01
,
Include levies for debt service, pension funds, and other funds or purposes.
Exclude any taxes you collected on behalf of other governments and taxes
not measured by value.
2.
,
.00
▼
Local sales taxes - Taxes on goods and services, measured as a percent of sales or
receipts, or as an amount per unit sold (gallon, package, etc.)
Include only taxes imposed by your government.
Exclude shares of taxes imposed by another government (report in Part 3 ).
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
E. Occupation and business licensing and permit taxes
$
(not reported above) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . T28
,
,
.00
,
,
.00
A. General sales tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . T09
B. Alcoholic beverages sales tax . . . . . . . . . . . . . . . . . . . . . . . .
T10
C. Amusements sales tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .T11
D. Motor fuels sales tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . T13
E. Parimutuels tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .T14
F.
Public utilities sales tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . T15
G. Tobacco products tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . T19
H. Other sales tax, specify:
3.
T16
Licensing and permit taxes - (e.g., license and inspection
charges on occupations, businesses, animals, vehicles, etc.)
A. Alcoholic beverages licensing and permit taxes . . . . . . . . . . . .T20
B. Amusements licensing and permit taxes . . . . . . . . . . . . . . . . . T21
C. Motor vehicles licensing and permit taxes . . . . . . . . . . . . . . . . T24
D. Public utilities licensing and permit taxes . . . . . . . . . . . . . . . .
F.
▲
F-28 (8-24-2009)
28200902
Other licensing and permit taxes, specify:
T27
▼
. . . T29
Please continue on the next page
$
▲
§=5(#¤
Page 3
Part 2
4.
TAX REVENUES - Continued
▼
Tax Revenues
Local income taxes
A. Local personal income, payroll, or earnings tax . . . . . . . . . . . . T40
B. Local corporation net income tax . . . . . . . . . . . . . . . . . . . . . . T41
5.
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
Other taxes
A. Death and gift tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . T50
B. Documentary and stock transfer tax . . . . . . . . . . . . . . . . . . . . T51
C. Severance tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .T53
D. Other taxes, specify:
. . . . . . T99
▲
▲
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F-28 (8-24-2009)
28200903
§=5($¤
Page 4
Part 3
INTERGOVERNMENTAL REVENUES
▼
Report all amounts received by your government 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 government received payments under the American Recovery
and Reinvestment Act of 2009 (ARRA), include them in the appropriate categories below.
Exclude loans, any taxes imposed by your government which were collected for it by another
government (reported in Part 2 ) and receipts from utility sales to other governments (report in Part 4 ).
From the State Include any amounts financed
wholly or in part from Federal
grants to the State
(i.e., pass-throughs).
From other local
governments
From the Federal
government directly
Exclude collection fees.
1. Streets and highways
D46
$
,
,
.00
C46
$
,
,
.00
B46
$
,
,
.00
2. Education
D21
$
,
,
.00
C21
$
,
,
.00
B21
$
,
,
.00
3. Public welfare
(including Medicaid)
D79
$
,
,
.00
C79
$
,
,
.00
B79
$
,
,
.00
4. Health and/or hospitals
D42
$
,
,
.00
C42
$
,
,
.00
B42
$
,
,
.00
5. Housing and community
development
D50
$
,
,
.00
C50
$
,
,
.00
B50
$
,
,
.00
6. Water supply system
D91
$
,
,
.00
C91
$
,
,
.00
B91
$
,
,
.00
7. Sewerage
D80
$
,
,
.00
C80
$
,
,
.00
B80
$
,
,
.00
▲
F-28 (8-24-2009)
28200904
Please continue on the next page
▲
§=5(%¤
Page 5
Part 3
INTERGOVERNMENTAL REVENUES - Continued
From the State Include any amounts financed
wholly or in part from Federal
grants to the State
(i.e., pass-throughs).
▼
From other local
governments
From the Federal
government directly
Exclude collection fees.
8. Electric power system
D92
$
,
,
.00
C92
$
,
,
.00
B92
$
,
,
.00
9. Gas supply system
D93
$
,
,
.00
C93
$
,
,
.00
B93
$
,
,
.00
10. Mass transit rail
and/or bus system
D94
$
,
,
.00
C94
$
,
,
.00
B94
$
,
,
.00
11. Airports
D89
$
,
,
.00
C89
$
,
,
.00
B01
$
,
,
.00
12. Natural resources
D89
$
,
,
.00
C89
$
,
,
.00
B59
$
,
,
.00
13. General support
(unrestricted)
D30
$
,
,
.00
C30
$
,
,
.00
B30
$
,
,
.00
D89
$
,
,
.00
$
,
,
.00
$
,
,
.00
14. All other, specify
▼
C89
▲
B89
▲
Please continue on the next page
F-28 (8-24-2009)
28200905
§=5(&¤
Page 6
Part 4
REVENUES - OTHER THAN TAX AND INTERGOVERNMENTAL REVENUES
Report other revenues received by your government during the fiscal year reported in Part 1 .
Include revenues of all funds except those noted in any separate instructions included with this form.
Exclude refunds and transfers between funds and accounts of your government.
1.
Utility sales revenues - Gross receipts of any water, electric, gas, or transit
systems operated by your government, from utility sales and charges.
▼
Include amounts received from the sale of utility commodities and services to the
local, State, or the Federal government.
Utility Sales Revenues
A. Water supply system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A91
B. Electric power system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A92
C. Gas supply system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A93
D. Transit or bus system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
A94
Other sales and service revenues - Gross receipts from fees, sales, rentals,
tolls, maintenance assessments, and other charges for commodities or services.
Exclude utility receipts (reported in item 1 above) and amounts received from
other governments (reported in Part 3 ).
Other Revenues
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
D. Airports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A01
Include rentals and gross sales of gas and oil.
$
E. Hospital charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A36
Include amounts received on behalf of individual
patients under the Medicare program or other
insurance-type arrangements.
Exclude Medicaid and the amounts for hospital purposes
received from other governments (reported in Part 3 ).
,
,
.00
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
A. Sewerage charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
A80
B. Refuse collection and disposal charges . . . . . . . . . . . . . . . . .
A81
C. Parks and Recreation charges . . . . . . . . . . . . . . . . . . . . . . . . A61
(swimming, golf, auditoriums, etc.)
F.
Parking facilities (lots, garages, meters, etc). . . . . . . . . . . . . .
A60
G. Housing project rentals (gross). . . . . . . . . . . . . . . . . . . . . . . . A50
H. Highways and other roads
Include bridges, tunnels, and ferries
(1) Operated on a fee or toll basis. . . . . . . . . . . . . . . . . A45
(2) Other street and highway charges. . . . . . . . . . . . . .
▲
F-28 (8-24-2009)
28200906
Please continue on the next page
A44
▲
§=5(’¤
Page 7
Part 4
REVENUES - OTHER THAN TAX AND INTERGOVERNMENTAL REVENUES
Continued
▼
2.
Other Revenues
Other sales and service revenues - cont’d
I.
Sea and inland port facilities. . . . . . . . . . . . . . . . . . . . . . . . . . A87
J.
Education
(1) K-12: Gross receipts from sale of school lunches. . .
A10
(3) K-12: Other school receipts. . . . . . . . . . . . . . . . . . .
A12
K. Miscellaneous commercial activities directly operated by
your government, such as cemeteries, cable television,
telephone utilities, rail lines, etc. . . . . . . . . . . . . . . . . . . . . . .
A03
L.
A59
M. Other sales and service revenues, specify
Include miscellaneous fee collections.
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
▼
..........
3.
,
A09
(2) K-12: School tuition and transportation charges . . . .
Natural resources charges. . . . . . . . . . . . . . . . . . . . . . . . . . .
$
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. . . . . . . . . . . . . . .
A89
U01
Exclude proceeds from sales of special assessment bonds
(report in Part 10 ) and maintenance assessments
(reported in item 2 above).
4.
Receipts from sale of property and other capital assets. . . . . . . . . . . . U11
Include property sold to other governments.
Exclude tax sales (reported in Part 2 ).
$
,
,
.00
5.
Interest earnings - Interest received on all deposits and
$
investment holdings of your government, and its agencies. . . . . . . . . . . . . U20
,
,
.00
Include interest on construction funds.
Exclude earnings of any employee pension fund.
6.
Fines and forfeits - Receipts from penalties imposed for
$
violations of law and civil penalties. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .U30
,
,
.00
7.
Rents - Revenues from temporary possession or use of
government-owned buildings, land, and other properties. . . . . . . . . . . . . .
,
,
.00
$
U40
▲
▲
Please continue on the next page
F-28 (8-24-2009)
28200907
§=5((¤
Page 8
Part 4
REVENUES - OTHER THAN TAX AND INTERGOVERNMENTAL REVENUES
Continued
▼
8.
9.
10.
Royalties - Compensation or portion of proceeds from
extraction of natural resources, such as oil, gas and
$
mineral rights. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . U41
Private donations - Gifts of cash or securities from
private individuals or corporations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other Revenues
,
,
.00
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
,
,
.00
$
U50
Miscellaneous other revenues - Revenues of your government and its
agencies not reported in items 1 through 9, or Parts 2 - 3 .
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 government, employee contributions to, and
interest earnings of, any employee pension fund.
Specify and report miscellaneous revenue:
A.
. . . . . . . . . . . . U99
B.
. . . . . . . . . . . U99
C.
. . . . . . . . . . . U99
D.
. . . . . . . . . . . U99
E.
. . . . . . . . . . . U99
Total Revenues
Part 5
TOTAL REVENUES (sum of Parts 2 - 4 ). . . . . . . . . REV
▲
$
,
,
.00
▲
Please continue on the next page
F-28 (8-24-2009)
28200908
§=5()¤
Page 9
Part 6
INTERGOVERNMENTAL EXPENDITURES
Report all payments made to other governments for services or programs performed
on a reimbursement or cost sharing basis.
▼
To other local governments
1. Highways
M44
Z00
2. Financial administration
M23
Z00
3. Central administration
M29
Z00
4. Fire protection
M24
Z00
5. Parks and recreation
M61
Z00
6. Solid waste management
M81
Z00
7. Sewerage
M80
Z00
8. Water supply system
M91
Z00
9. Hospitals
M36
Z00
10. Health (other than hospitals)
M32
Z00
To the State
$
,
,
.00
L44
$
,
,
.00
$
,
,
.00
L23
$
,
,
.00
$
,
,
.00
L29
$
,
,
.00
$
,
,
.00
L89
$
,
,
.00
$
,
,
.00
L61
$
,
,
.00
$
,
,
.00
L81
$
,
,
.00
$
,
,
.00
L80
$
,
,
.00
$
,
,
.00
L91
$
,
,
.00
$
,
,
.00
L36
$
,
,
.00
$
,
,
.00
L32
$
,
,
.00
▲
▲
Please continue on the next page
F-28 (8-24-2009)
28200909
§=5(*¤
Page 10
Part 6
INTERGOVERNMENTAL EXPENDITURES - Continued
▼
To other local governments
11. Police protection
M62
Z00
12. Judicial and legal services
M25
Z00
13. Correctional institutions
M04
Z00
14. Other correctional activities
M05
Z00
15. Libraries
M52
Z00
16. Public welfare
M79
Z00
17. Protective inspection
M66
Z00
18. Housing and community
development
M50
Z00
19. Natural resources
M59
Z00
20. Airports
M01
Z00
To the State
$
,
,
.00
L62
$
,
,
.00
$
,
,
.00
L25
$
,
,
.00
$
,
,
.00
L04
$
,
,
.00
$
,
,
.00
L05
$
,
,
.00
$
,
,
.00
L52
$
,
,
.00
$
,
,
.00
L79
$
,
,
.00
$
,
,
.00
L66
$
,
,
.00
$
,
,
.00
L50
$
,
,
.00
$
,
,
.00
L59
$
,
,
.00
$
,
,
.00
L01
$
,
,
.00
▲
▲
Please continue on the next page
F-28 (8-24-2009)
28200910
§=5(+¤
Page 11
Part 6
INTERGOVERNMENTAL EXPENDITURES - Continued
▼
To other local governments
To the State
21. Electric supply system
M92
$
,
,
.00
L92
$
,
,
.00
22. Parking
M60
$
,
,
.00
L60
$
,
,
.00
23. Natural gas supply system
M93
$
,
,
.00
L93
$
,
,
.00
24. Transit
M94
$
,
,
.00
L94
$
,
,
.00
25. Sea and inland port facilities
M87
$
,
,
.00
L87
$
,
,
.00
26. Education
(elementary, secondary)
M12
$
,
,
.00
L12
$
,
,
.00
M18
$
,
,
.00
L18
$
,
,
.00
M89
$
,
,
.00
L89
$
,
,
.00
27. Education (post-secondary)
28. Other, specify:
▼
Check here if your government made no payments to other governments during the fiscal year
reported in Part 1 .
▲
▲
Please continue on the next page
F-28 (8-24-2009)
28200911
§=5(,¤
Page 12
Part 7
DIRECT EXPENDITURES BY PURPOSE AND TYPE
Report amounts expended during the fiscal year indicated in Part 1 .
Include expenditures of all funds except those noted in any separate instructions with this form.
Exclude:
• Transfer 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.
Capital Outlays
Include gross salaries and
wages before deductions.
▼
1. Toll highways - maintenance,
operation, repair, and
construction of highways, roads,
bridges, ferries, and tunnels
operated on a fee or toll basis.
2. Highways - Construction and
maintenance of roads, sidewalks
and bridges; street lighting; snow
removal; highway engineering,
control, and safety.
Purchase of
equipment, land and
existing structures
Exclude capital outlays and
depreciation/amortization
Construction
Include capital leases
E45
$
,
,
.00
F45
$
,
,
.00
G45
$
,
,
.00
E44
$
,
,
.00
F44
$
,
,
.00
G44
$
,
,
.00
E23
$
,
,
.00
F23
$
,
,
.00
G23
$
,
,
.00
E29
$
,
,
.00
F29
$
,
,
.00
G29
$
,
,
.00
Exclude street cleaning
expenditures (report in item 7).
3. Financial administration office of the finance director,
auditor, comptroller, treasurer; tax
assessment and collection;
central accounting and purchasing
services, budgeting, etc.
4. Central administration county or city council, aldermen or
commissioners; county, city or
town administrator or manager;
clerks office, recorder, planning,
zoning and personnel.
▲
▲
Please continue on the next page
F-28 (8-24-2009)
28200912
§=5(-¤
Page 13
Part 7
DIRECT EXPENDITURES BY PURPOSE AND TYPE - Continued
Current Operation
▼
5. Fire - firefighting and fire
prevention.
Capital Outlays
Direct expenditures
including salaries and
wages
Purchase of
equipment, land and
existing structures
Construction
E24
$
,
,
.00
F24
$
,
,
.00
G24
$
,
,
.00
E61
$
,
,
.00
F61
$
,
,
.00
G61
$
,
,
.00
E81
$
,
,
.00
F81
$
,
,
.00
G81
$
,
,
.00
E80
$
,
,
.00
F80
$
,
,
.00
G80
$
,
,
.00
E91
$
,
,
.00
F91
$
,
,
.00
G91
$
,
,
.00
E36
$
,
,
.00
F36
$
,
,
.00
G36
$
,
,
.00
Include ambulance and
paramedic services handled by
the fire department and
contributions of volunteer fire
units.
Exclude any contributions to a
local fire pension fund and forest
fire protection amounts (report in
item 21).
6. Parks and recreation playgrounds; golf courses;
swimming pools; museums;
marinas; community music, drama,
festivals; zoos, and other cultural
activities.
7. Solid waste management street cleaning and the collection,
recycling and disposal of refuse
and garbage.
8. Sewerage - construction,
maintenance and operation of
sanitary and storm sewer systems
and sewage disposal plants.
9. Water supply system
10. Hospitals - construction and
operation of hospitals by your
government; payments to
hospitals operated privately.
▲
▲
Please continue on the next page
F-28 (8-24-2009)
28200913
§=5(.¤
Page 14
Part 7
DIRECT EXPENDITURES BY PURPOSE AND TYPE - Continued
Current Operation
▼
11. Health (other than
hospitals) - all public health
activities; except provision of
hospital care.
Capital Outlays
Direct expenditures
including salaries and
wages
Purchase of
equipment, land and
existing structures
Construction
E32
$
,
,
.00
F32
$
,
,
.00
G32
$
,
,
.00
E62
$
,
,
.00
F62
$
,
,
.00
G62
$
,
,
.00
E25
$
,
,
.00
F25
$
,
,
.00
G25
$
,
,
.00
Include environmental health
activities; health regulation and
inspection, water and air pollution
control, mosquito control, animal
control warden, inspection of food
handling establishments, and
ambulance and paramedic
services not part of a fire
department. Also include public
health nursing, vital statistics
collection, and all other services
performed directly by the public
health department.
Exclude payments under public
welfare programs (report in item
18).
12. Police police agencies for
preventing, controlling, or
reducing crime; law enforcement
activities or sheriff and constable
offices; coroners; medical
examiners; vehicular inspection
activities; traffic control and
safety activities; lock-up
operations.
Exclude your contribution to a
local police pension fund; local
court activities (report in item 13),
and local correction activities
(report in items 14 and 15).
13. Judicial and legal - all
county or municipal court and
court-related activities including
juries, probate officials,
prosecutors, bailiffs, marshals,
public defenders, attorneys, legal
departments, and court activities
of sheriffs departments.
Exclude probation and parole
(report in item 15).
▲
F-28 (8-24-2009)
28200914
Please continue on the next page
▲
§=5(/¤
Page 15
Part 7
DIRECT EXPENDITURES BY PURPOSE AND TYPE - Continued
Current Operation
▼
14. Correctional institutions construction, maintenance, and
operation of correctional facilities,
reformatories, detention facilities,
etc., whether for adults or
juveniles.
Capital Outlays
Direct expenditures
including salaries and
wages
Purchase of
equipment, land and
existing structures
Construction
E04
$
,
,
.00
F04
$
,
,
.00
G04
$
,
,
.00
E05
$
,
,
.00
F05
$
,
,
.00
G05
$
,
,
.00
E31
$
,
,
.00
F31
$
,
,
.00
G31
$
,
,
.00
E52
$
,
,
.00
F52
$
,
,
.00
G52
$
,
,
.00
Exclude activities related to
probation and parole (report in
item 15).
15. Other corrections - activities
related to probation and parole,
training of corrections officers,
nonresidential halfway houses,
and community corrections
centers.
16. General public buildings construction, maintenance, and
operation of government office
buildings not relating to particular
purposes.
Report single-purpose buildings
(firehouses, hospitals, etc.) at the
purpose specified.
17. Libraries - payments to
nongovernmental libraries as well
as expenditures for libraries
operated by your government.
▲
▲
Please continue on the next page
F-28 (8-24-2009)
28200915
§=5(0¤
Page 16
Part 7
DIRECT EXPENDITURES BY PURPOSE AND TYPE - Continued
Current Operation
▼
Capital Outlays
Direct expenditures
including salaries and
wages
Purchase of
equipment, land and
existing structures
Construction
18. Public welfare - support of,
and assistance to, needy persons,
including expenditures from State
and Federal grants.
A.
B.
C.
D.
E.
F.
Money paid directly to
needy persons covered
by Federal aid programs
(Temporary Assistance
for Needy Families).
Money paid directly to
needy persons not
covered by Federal aid
programs (general relief,
home relief, poor relief,
etc.)
Payments to landlords,
utilities, vendors, etc.,
for rent, goods, and
services furnished to
needy persons, other
than for medical and
hospital care.
Payments to private
vendors for medical and
hospital care provided to
needy persons. Exclude
payments to hospital or
health agencies
operated by your
government (reported
in items 10 and 11).
Welfare institutions
operated by your
government, including
nursing homes,
veterans’ homes, homes
for the elderly, and
indigent care institutions.
Other public welfare Administration of relief
and assistance, foster
care, related community
action programs, and
other welfare activities
not reported in A,
B, C, D and E above.
J67
$
,
,
.00
J68
$
,
,
.00
E75
$
,
,
.00
E74
$
,
,
.00
E77
$
,
,
.00
F77
$
,
,
.00
G77
$
,
,
.00
E79
$
,
,
.00
F79
$
,
,
.00
G79
$
,
,
.00
Exclude any payments to the
State for your government’s share
of the welfare costs (reported in
Part 6 ).
▲
F-28 (8-24-2009)
28200916
Please continue on the next page
▲
§=5(1¤
Page 17
Part 7
DIRECT EXPENDITURES BY PURPOSE AND TYPE - Continued
Current Operation
▼
19. Protective inspection and
regulation - regulation of private
enterprise for the protection of the
public and inspection of
hazardous activities (including
building inspection), except when
related to major functions, such as
health, natural resources, etc.
Capital Outlays
Direct expenditures
including salaries and
wages
Purchase of
equipment, land and
existing structures
Construction
E66
$
,
,
.00
F66
$
,
,
.00
G66
$
,
,
.00
E50
$
,
,
.00
F50
$
,
,
.00
G50
$
,
,
.00
E59
$
,
,
.00
F59
$
,
,
.00
G59
$
,
,
.00
22. Airports
E01
$
,
,
.00
F01
$
,
,
.00
G01
$
,
,
.00
23. Electric power system
E92
$
,
,
.00
F92
$
,
,
.00
G92
$
,
,
.00
E60
$
,
,
.00
F60
$
,
,
.00
G60
$
,
,
.00
25. Gas supply system
E93
$
,
,
.00
F93
$
,
,
.00
G93
$
,
,
.00
26. Transit or bus system
E94
$
,
,
.00
F94
$
,
,
.00
G94
$
,
,
.00
20. Housing and community
development - gross
expenditures for urban renewal
housing projects, and similar
activities.
21. Natural resources - flood
control, soil and water
conservation, drainage, irrigation,
forestry and forest fire protection,
agricultural fairs, and any other
activities for promotion of
agriculture and conservation of
natural resources.
24. Parking facilities - garages,
parking lots, and all purchases
and maintenance of meters, etc.
▲
▲
Please continue on the next page
F-28 (8-24-2009)
28200917
§=5(2¤
Page 18
Part 7
DIRECT EXPENDITURES BY PURPOSE AND TYPE - Continued
Current Operation
▼
27. Sea and inland port
facilities - docks, wharves,
harbors, piers, canals, waterways
and related warehouses.
Capital Outlays
Direct expenditures
including salaries and
wages
Purchase of
equipment, land and
existing structures
Construction
E87
$
,
,
.00
F87
$
,
,
.00
G87
$
,
,
.00
E03
$
,
,
.00
F03
$
,
,
.00
G03
$
,
,
.00
E12
$
,
,
.00
F12
$
,
,
.00
G12
$
,
,
.00
A. Interest on water supply
system debt. . . . . . . . . . . . . .
I91
$
,
,
.00
B. Interest on electric power
system debt. . . . . . . . . . . . . .
I92
$
,
,
.00
C. Interest on gas supply
system debt. . . . . . . . . . . . . .
I93
$
,
,
.00
D. Interest on transit or bus
system debt. . . . . . . . . . . . . .
I94
$
,
,
.00
E. Interest on all other debt. . . . .
I89
$
,
,
.00
28. Miscellaneous commercial
activities - directly operated by
your government, such as
cemeteries, cable television,
telephone utilities, rail lines, etc.
29. Education - if your
government does not directly
administer schools, report any
expenditures for school purposes.
If your government does directly
administer schools, please see
any separate instructions for your
state.
Exclude payments to local school
districts (reported in Part 6 ).
30. Interest on debt - amounts
of interest paid, including any
interest on short-term or nonguaranteed obligations as well as
general obligations.
Include capitalized interest paid
on construction loans.
▲
F-28 (8-24-2009)
28200918
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▲
§=5(3¤
Page 19
Part 7
DIRECT EXPENDITURES BY PURPOSE AND TYPE - Continued
31. All other expenditures - any amounts which have not been allocated above by purpose.
Include:
•
•
•
•
Your employer contribution to a state administered retirement system or to the
Federal Social Security Administration
Judgements and insurance premiums
Government service agencies, such as a central garage or an IT or engineering department which serves
more than one functional agency, and whose expenses are not allocated to the various departments
Recorded losses from sale of investments
Exclude:
•
•
•
•
Payments for retirement of debt
Payments for purchase of securities
Transfers between funds or agencies of your government
Benefits and payments from self-administered employee pension funds
▼
Other - specify
Current Operation
Capital Outlays
Direct expenditures
including salaries and
wages
Purchase of
equipment, land and
existing structures
Construction
A.
E89
$
,
,
.00
F89
$
,
,
.00
G89
$
,
,
.00
B.
E89
$
,
,
.00
F89
$
,
,
.00
G89
$
,
,
.00
C.
E89
$
,
,
.00
F89
$
,
,
.00
G89
$
,
,
.00
D.
E89
$
,
,
.00
F89
$
,
,
.00
G89
$
,
,
.00
E.
E89
$
,
,
.00
F89
$
,
,
.00
G89
$
,
,
.00
F.
E89
$
,
,
.00
F89
$
,
,
.00
G89
$
,
,
.00
Total Expenditures
Part 8
▲
F-28 (8-24-2009)
28200919
TOTAL EXPENDITURES (sum of Parts 6 - 7 ). . . .
Please continue on the next page
EXP
$
,
,
.00
▲
§=5(4¤
Page 20
Part 9
PERSONNEL EXPENDITURES
Report total expenditures for salaries and wages reported in Part 7 ,
including any paid to employees of your government working on
construction projects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Part 10
Personnel Expenditures
Z00
$
,
,
.00
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.
Long-term Debt
for Public Purposes
What is your government’s debt for all public purposes?
$
,
,
.00
$
,
,
.00
39U
$
,
,
.00
49U
$
,
,
.00
19U
A.
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 (item 1.A + 1.B - 1.C) . . . . . =
29U
2.
▲
-
What is your government’s debt for privately owned housing,
industrial, or business purposes? This category is applicable
only to those governments authorized to issue debt of this type (e.g.,
industrial development revenue bonds, pollution control revenue bonds, etc.)
Long-term Debt
for Private Purposes
$
,
,
.00
$
,
,
.00
34T
$
,
,
.00
44T
$
,
,
.00
19T
A.
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 (item 2.A + 2.B - 2.C) . . . . . =
24T
-
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
3.
Amount outstanding at beginning of fiscal year . . . . . . . . . . . . . . . . .
61V
4.
Amount outstanding at end of fiscal year . . . . . . . . . . . . . . . . . . . . . .
64V
▲
F-28 (8-24-2009)
28200920
Please continue on the next page
$
,
,
.00
$
,
,
.00
▲
§=5(5¤
Page 21
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.
2.
3.
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.
Unexpended proceeds from sale of bond issues held pending
disbursement (e.g., bond funds). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
All other cash and investments - checking/savings accounts,
CD’s, stocks, bonds, mutual funds, etc. . . . . . . . . . . . . . . . . . . . . . . . . . .
Exclude employee retirement funds.
Part 12
REMARKS
Part 13
CERTIFICATION
Amount at end
of fiscal year
$
,
,
.00
$
,
,
.00
$
,
,
.00
W01
W31
W61
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
Email Address - Please print
Area Code
Number
▲
Thank you for your report. Please return to:
Ext.
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 3.0 to 40.0 hours per response, with an average of 6.0 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 Paperwork@census.gov; use "Paperwork Project 0607-0585" as the subject.
Census Use Only
F-28 (8-24-2009)
28200921
BEG
REV
EXP
REP
DIFF
V98
END
§=5(6¤
| File Type | application/pdf |
| File Title | untitled |
| File Modified | 2010-06-23 |
| File Created | 2009-08-24 |