Report CS2171 2008bloomfieldannualreport
User Manual: CS2171
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STATE OF INDIANA STATE BOARD OF ACCOUNTS 302 W. WASHINGTON ST., E418 INDIANAPOLIS, IN 46204-2765 TELEPHONE: (317) 232-2513 FEDERAL IDENTIFICATION NUMBER: 35-6003092 UNIT NAME: Bloomfield Township COUNTY: Lagrange TOWNSHIP FORM 15 (REVISED 2008) ANNUAL TOWNSHIP FINANCIAL REPORT PRESCRIBED BY THE STATE BOARD OF ACCOUNTS FOR THE FISCAL YEAR THAT ENDED 2008 ID: 44-2-1 (State Board of Accounts USE ONLY) CONTENTS: TOWNSHIP THE THE THE THE PART 1 - STATEMENT OF RECEIPTS, DISBURSEMENTS, CASH BALANCES AND INVESTMENT BALANCES (ADVERTISE) PART 2 - RECEIPTS (ADVERTISE) PART 3A - DISBURSEMENTS PART 3B - DISBURSEMENTS (ADVERTISE) PART 4 - CASH AND INVESTMENTS PART 5 - INDEBTEDNESS (ADVERTISE) PART 6 - INTERGOVERNMENTAL EXPENDITURES PART 7 - STATEMENT OF FEDERAL GRANT RECEIPTS PART 8 - STATEMENT OF STATE GRANT RECEIPTS PART 9 - CERTIFICATE (ADVERTISE) PART 10 - ADVERTISEMENT AND NOTE TO PUBLISHERS PART 11 - POOR RELIEF STATISTICAL REPORT PART 12 - FINANCIAL ASSISTANCE TO NONGOVERNMENTAL ENTITIES TRUSTEES ANNUAL REPORT TO: TOWNSHIP BOARD COUNTY AUDITOR STATE BOARD OF ACCOUNTS U.S. BUREAU OF CENSUS TOWNSHIP: Bloomfield Township COUNTY: Lagrange FOR THE FISCAL YEAR ENDED 2008 FILED IN THE COUNTY AUDITOR'S OFFICE ON: 01/20/2009 TITLE: William PRINTED NAME OF OFFICIAL: 818 N. Detroit Street ADDRESS: TELEPHONE (BETWEEN THE HOURS OF Township Trustee Pipher 8:00 AM AND CITY: 5:00 PM): (260) 463-3411 ZIP: LaGrange 46761-0000 (TOWNSHIP FORM 15) ANNUAL FINANCIAL REPORT UNIT NAME: Bloomfield Township ID: 44-2-1 COUNTY: Lagrange PART 1 - STATEMENT OF RECEIPTS, DISBURSEMENTS, CASH BALANCES, AND INVESTMENT BALANCES FOR THE FISCAL YEAR ENDING 2008 PAGE: 1 Beginning Cash Ending Cash Total Cash and Funds Fund Balances 2008 2008 Fund Balances Investments Investments 01/01/2008 Receipts Disbursements 12/31/2008 at 12/31/2008 at 12/31/2008 Section I FUND TYPE: GENERAL 1 GENERAL $22,740.34 $40,707.36 $67,996.32 $-4,548.62 $50,000.00 $45,451.38 Total by Fund Type: $22,740.34 $40,707.36 $67,996.32 $-4,548.62 $50,000.00 $45,451.38 $10,316.58 $6,338.82 $12,853.07 $3,802.33 $50,000.00 $53,802.33 $0.00 $4,456.17 $0.00 $4,456.17 $0.00 $4,456.17 81 TOWNSHIP ASSISTANCE $40,096.00 $19,256.24 $24,499.48 $34,852.76 $0.00 $34,852.76 Total by Fund Type: $50,412.58 $30,051.23 $37,352.55 $43,111.26 $50,000.00 $93,111.26 16 CUMULATIVE FIRE $93,168.71 $62,540.63 $96,191.73 $59,517.61 $150,000.00 $209,517.61 Total by Fund Type: $93,168.71 $62,540.63 $96,191.73 $59,517.61 $150,000.00 $209,517.61 91 LEVY EXCESS AGENCY $272.58 $0.00 $272.58 $0.00 $0.00 $0.00 Total by Fund Type: $272.58 $0.00 $272.58 $0.00 $0.00 $0.00 Subtotal All Funds: $166,594.21 $133,299.22 $201,813.18 $98,080.25 $250,000.00 $348,080.25 FUND TYPE: SPECIAL REVENUE 11 FIREFIGHTING 61 RAINY DAY FUND TYPE: CAPITAL PROJECTS FUND TYPE: AGENCY Section II Less: Investment Sales $0.00 $50,000.00 Investment Purchases Transfers In $272.58 $272.58 Transfers Out Net Receipts and Disbursements $133,026.64 $151,540.60 (TOWNSHIP FORM 15) ANNUAL FINANCIAL REPORT ID: 44-2-1 UNIT Bloomfield Township PART 2 - RECEIPTS COUNTY: Lagrange FOR THE FISCAL YEAR ENDING 2008 Title Fund: COMMERCIAL VEHICLE EXCISE TAX $2,346.64 $562.76 $380.00 GENERAL PROPERTY TAXES $28,155.14 Total for: TAXES INTEREST EARNED MISCELLANEOUS REVENUE-OTHER Total for: MISCELLANEOUS REFUNDS-OTHER TRANSFER OF FUNDS-OTHER Total for: OTHER FINANCING SOURCES TOTAL RECEIPTS FOR 1 GENERAL $4,077.00 $35,521.54 $2,540.24 $5.18 $2,545.42 $2,367.82 $272.58 $2,640.40 $40,707.36 11 FIREFIGHTING AUTO AND AIRCRAFT EXCISE TAX COMMERCIAL VEHICLE EXCISE TAX $370.68 $13.84 FINANCIAL INSTITUTION TAX $7.00 GENERAL PROPERTY TAXES $4,169.45 Total for: $4,560.97 TAXES INTEREST EARNED $1,777.85 Total for: $1,777.85 MISCELLANEOUS TOTAL RECEIPTS FOR 11 FIREFIGHTING $6,338.82 61 RAINY DAY CERTIFIED SHARES (LOCAL OPTION TAX) $4,456.17 Total for: $4,456.17 TAXES TOTAL RECEIPTS FOR 61 RAINY DAY Fund: Amount FINANCIAL INSTITUTION TAX PROPERTY TAX REPLACEMENT CREDIT (LOCAL OPTION TAX) Fund: 1 1 GENERAL AUTO AND AIRCRAFT EXCISE TAX Fund: PAGE: $4,456.17 81 TOWNSHIP ASSISTANCE AUTO AND AIRCRAFT EXCISE TAX $1,416.68 COMMERCIAL VEHICLE EXCISE TAX $331.24 FINANCIAL INSTITUTION TAX $223.00 GENERAL PROPERTY TAXES $16,959.80 Total for: TAXES $18,930.72 REFUNDS-OTHER $325.52 Total for: OTHER FINANCING SOURCES $325.52 TOTAL RECEIPTS FOR 81 TOWNSHIP ASSISTANCE $19,256.24 (TOWNSHIP FORM 15) ANNUAL FINANCIAL REPORT ID: 44-2-1 UNIT Bloomfield Township PART 2 - RECEIPTS COUNTY: Lagrange FOR THE FISCAL YEAR ENDING 2008 Title Fund: PAGE: 2 Amount 16 CUMULATIVE FIRE AUTO AND AIRCRAFT EXCISE TAX CERTIFIED SHARES (LOCAL OPTION TAX) $1,663.55 $36,130.00 COMMERCIAL VEHICLE EXCISE TAX $62.16 FINANCIAL INSTITUTION TAX $29.00 GENERAL PROPERTY TAXES $18,711.67 Total for: $56,596.38 TAXES INTEREST EARNED $5,944.25 Total for: $5,944.25 MISCELLANEOUS TOTAL RECEIPTS FOR 16 CUMULATIVE FIRE Total Receipts: $62,540.63 $133,299.22 (TOWNSHIP FORM 15) ANNUAL FINANCIAL REPORT ID: 44-2-1 PART 3A, Page 1- DISBURSEMENTS COUNTY: Lagrange FOR THE FISCAL YEAR ENDING 2008 UNIT NAME: Bloomfield Township Fund: PAGE: 1 1 GENERAL Dept: TWP FUND-GENERAL GOVERNMENT PERSONAL SERVICES SUPPLIES OTHER SERVICES AND CHARGES CAPITAL OUTLAY TOTAL $53,807.77 $960.19 $13,088.38 $139.98 $67,996.32 BY OBJECT FOR GENERAL PERSONAL SERVICES SUPPLIES $960.19 OTHER SERVICES AND CHARGES CAPITAL OUTLAY $13,088.38 $139.98 OTHER DISBURSEMENTS $0.00 TRANSFER OF FUNDS $0.00 PURCHASE OF INVESTMENTS $0.00 MEDICAL, HOSPITAL, AND BURIAL TOTAL GENERAL Fund: $53,807.77 $0.00 $67,996.32 81 TOWNSHIP ASSISTANCE Dept: TOWNSHIP ASSISTANCE ADMINISTRATION PERSONAL SERVICES OTHER SERVICES AND CHARGES $4,229.50 $3,612.98 TOTAL Dept: TOWNSHIP ASSISTANCE DIRECT ASSISTAN $7,842.48 MEDICAL, HOSPITAL, AND BURIAL $2,171.29 TOTAL Dept: TOWNSHIP ASSISTANCE OTHER ASSISTANC OTHER DISBURSEMENTS TOTAL $2,171.29 $14,485.71 $14,485.71 BY OBJECT FOR TOWNSHIP ASSISTANCE PERSONAL SERVICES SUPPLIES OTHER SERVICES AND CHARGES CAPITAL OUTLAY OTHER DISBURSEMENTS TRANSFER OF FUNDS PURCHASE OF INVESTMENTS MEDICAL, HOSPITAL, AND BURIAL TOTAL TOWNSHIP ASSISTANCE $4,229.50 $0.00 $3,612.98 $0.00 $14,485.71 $0.00 $0.00 $2,171.29 $24,499.48 (TOWNSHIP FORM 15) ANNUAL FINANCIAL REPORT ID: 44-2-1 PART 3A, Page 2- DISBURSEMENTS COUNTY: Lagrange FOR THE FISCAL YEAR ENDING 2008 UNIT NAME: Bloomfield Township Fund: OTHER SERVICES AND CHARGES 16 CUMULATIVE FIRE TOTAL $46,191.73 $50,000.00 $96,191.73 91 LEVY EXCESS AGENCY TRANSFER OF FUNDS TOTAL TOTAL: $12,853.07 $12,853.07 CAPITAL OUTLAY PURCHASE OF INVESTMENTS Fund: 1 11 FIREFIGHTING TOTAL Fund: PAGE: $272.58 $272.58 $109,317.38 (TOWNSHIP FORM 15) ANNUAL FINANCIAL REPORT ID: 44-2-1 PART 3B- DISBURSEMENTS COUNTY: Lagrange FOR THE FISCAL YEAR ENDING 2008 UNIT NAME: Bloomfield Township Fund: 1 1 GENERAL Dept: TWP FUND-GENERAL GOVERNMENT Object: PERSONAL SERVICES To Whom Paid: Amount Bowen, Steven $378.00 Connelly, Allen $900.00 Elliott II, Robert Farmers State Bank Group Administrators LaGrange County Merrifield, Patricia P.E.R.F. $522.00 $2,711.88 $1,740.37 $13,218.00 $900.00 $1,687.52 Pipher, Susan C. $13,000.00 Pipher, William L. $18,750.00 TOTAL Object: PERSONAL SERVICES SUPPLIES $53,807.77 Postmaster $189.00 Staples $754.86 Wal-Mart TOTAL Object: SUPPLIES OTHER SERVICES AND CHARGES Auto Owners Boggs Pro Lawn Service, Inc. C&C Law Enforcement Support Combined Agency Data Systems $16.33 $960.19 $224.14 $3,200.00 $110.00 $1,948.00 $625.00 Embarq $1,000.00 LaGrange Chiropractic Offices $4,800.00 LaGrange County Trustees Assoc LaGrange Publishing Co. Verizon Wireless TOTAL Object: OTHER SERVICES AND CHARGES CAPITAL OUTLAY Staples TOTAL CAPITAL OUTLAY TOTAL Fund: PAGE: $20.00 $1,031.04 $130.20 $13,088.38 $139.98 $139.98 $67,996.32 11 FIREFIGHTING Dept: FIREFIGHTING Object: OTHER SERVICES AND CHARGES 5 Alarm Fire & Safety Equip. Town of LaGrange TOTAL OTHER SERVICES AND CHARGES $2,853.07 $10,000.00 $12,853.07 (TOWNSHIP FORM 15) ANNUAL FINANCIAL REPORT ID: 44-2-1 PART 3B- DISBURSEMENTS COUNTY: Lagrange FOR THE FISCAL YEAR ENDING 2008 UNIT NAME: Bloomfield Township TOTAL Fund: PAGE: 2 $12,853.07 81 TOWNSHIP ASSISTANCE Dept: TOWNSHIP ASSISTANCE ADMINISTRATION Object: PERSONAL SERVICES To Whom Paid: Farmers State Bank Pipher, Susan C. TOTAL Object: PERSONAL SERVICES OTHER SERVICES AND CHARGES Data Systems Eberhard & Gastineau Amount $229.50 $4,000.00 $4,229.50 $625.00 $250.00 LaGrange Chiropractic Offices $1,200.00 Verizon Wireless $1,537.98 TOTAL OTHER SERVICES AND CHARGES TOTAL Dept: TOWNSHIP ASSISTANCE DIRECT ASSISTAN Object: $3,612.98 $7,842.48 MEDICAL, HOSPITAL, AND BURIAL Carney-Frost Funeral Home $1,000.00 Millers Pharmacy $1,171.29 TOTAL MEDICAL, HOSPITAL, AND BURIAL TOTAL Dept: TOWNSHIP ASSISTANCE OTHER ASSISTANC Object: $2,171.29 $2,171.29 OTHER DISBURSEMENTS CS Investment Clothes & Food Basket $700.00 $1,000.00 Country Place Apartments $375.00 Crabapple Cove $300.00 Hershberger, Joseph $725.00 Hicks, Jerry $1,119.00 L A Express $270.00 LaGrange Apartments LaGrange County REMC $167.00 $1,254.94 LaGrange Villas II $295.00 LaGrange Water & Sewer $630.22 Lightning Hills Apartments $3,437.00 Maples, Dale $800.00 Miller, Mary B. $700.00 Millers Super Valu $19.42 Morningstar, Dan $330.00 NIPSCO $888.13 Raatz, Brian $500.00 (TOWNSHIP FORM 15) ANNUAL FINANCIAL REPORT ID: 44-2-1 PART 3B- DISBURSEMENTS COUNTY: Lagrange FOR THE FISCAL YEAR ENDING 2008 UNIT NAME: Bloomfield Township Object: $550.00 Smith, Tia $425.00 TOTAL OTHER DISBURSEMENTS $14,485.71 $14,485.71 16 CUMULATIVE FIRE Dept: CUMULATIVE FIRE Object: CAPITAL OUTLAY Danko Emergency Equipment Co. Town of LaGrange TOTAL Object: CAPITAL OUTLAY PURCHASE OF INVESTMENTS Farmers State Bank TOTAL PURCHASE OF INVESTMENTS TOTAL $44,352.75 $1,838.98 $46,191.73 $50,000.00 $50,000.00 $96,191.73 91 LEVY EXCESS AGENCY Dept: LEVY EXCESS AGENCY Object: TRANSFER OF FUNDS Bloomfield Township TOTAL TOTAL TOTAL: Amount Shaffer, Russell TOTAL Fund: 3 OTHER DISBURSEMENTS To Whom Paid: Fund: PAGE: TRANSFER OF FUNDS $272.58 $272.58 $272.58 $201,813.18 (TOWNSHIP FORM 15) ANNUAL FINANCIAL REPORT UNIT NAME: COUNTY: Bloomfield Township Lagrange ID: PART 4 - CASH AND INVESTMENTS FOR THE FISCAL YEAR ENDING 2008 PAGE: 44-2-1 1 CASH Purchase Date Fund Name Description CHECKING ACCOUNT Serial No./Acct. No. Investment Balance, Jan 1 Maturity Date Interest Rate 3598027 Purchase Cost $98,080.25 Total CASH: $98,080.25 INVESTMENTS Purchase Date 07/09/2008 Fund Name 1 GENERAL Description CERTIFICATE OF DEPOSIT Serial No./Acct. No. 1002785 Investment Balance, Jan 1 $50,000.00 Maturity Date 07/09/2009 Interest Rate 2.90 Total by Fund: 07/09/2008 $50,000.00 $50,000.00 11 FIREFIGHTING CERTIFICATE OF DEPOSIT 1002786 $50,000.00 07/09/2009 2.90 Total by Fund: 01/16/2008 Purchase Cost $50,000.00 $50,000.00 16 CUMULATIVE FIRE CERTIFICATE OF DEPOSIT 1002417 $150,000.00 01/16/2009 4.00 $150,000.00 Total by Fund: $150,000.00 Total INVESTMENTS: $250,000.00 Total Cash and Investments: $348,080.25 (TOWNSHIP FORM 15) ANNUAL FINANCIAL REPORT UNIT NAME: COUNTY: Bloomfield Township Lagrange ID: PAGE: 44-2-1 1 FOR THE FISCAL YEAR ENDING 2008 PART 5 - INDEBTEDNESS OUTSTANDING 1-1- (BEGINNING YEAR) PRINCIPAL ISSUED DURING YEAR PRINCIPAL RETIRED DURING YEAR OUTSTANDING 12-31- (ENDING YEAR) INTEREST PAID DURING (FULL YEAR) PRINCIPAL AND INTEREST DUE NEXT YEAR PART 6 - INTERGOVERNMENTAL EXPENDITURES FIRE PROTECTION OF THE EXPENDITURES REPORTED IN PART 3, HOW MUCH WAS PAID TO OTHER GOVERNMENTAL UNITS FOR: $11,838.98 TOTAL PAID TO LOCAL GOVERNMENTS $11,838.98 TOTAL PAID TO LOCAL AND STATE GOVERNMENTS $11,838.98 (TOWNSHIP FORM 15) ANNUAL FINANCIAL REPORT UNIT NAME: Bloomfield Township COUNTY: Lagrange PART 7 - STATEMENT OF FEDERAL GRANT RECEIPTS, DISBURSEMENTS AND BALANCES FOR THE FISCAL YEAR ENDING 2008 CFDA Number Federal Title Agency Award Amount Fund Title ID: PAGE: Receipts 44-2-1 1 Disbursements (TOWNSHIP FORM 15) ANNUAL FINANCIAL UNIT NAME: Bloomfield Township COUNTY: Lagrange PART 8 - STATEMENT OF STATE GRANT RECEIPTS, DISBURSEMENTS AND BALANCES FOR THE FISCAL YEAR ENDING 2008 Grant Number Project Name State Agency Award Amount Fund Title ID: PAGE: Receipts 44-2-1 1 Disbursements PART 9 - CERTIFICATION NOTE: Prepare five copies of this report to be presented to the Township Board for approval on or before the third Tuesday after the first Monday in January. After approval, one copy is to be retained by the Chairman of the Township Board. One copy is to be kept on file by the Township Trustee. Within ten (10) days, one copy, together with all vouchers, shall be filed with the County Auditor (IC 36-6-4-12(d)). In addition, one copy, along with advertising instructions, is to be submitted to each newspaper for which this report is to be published, within four (4) weeks after the third Tuesday following the first Monday in January (IC 5-3-1 and IC 36-6-4-13(b)). The advertisement must state that a complete and detailed annual report, and the accompanying vouchers showing the names of persons paid money by the township, have been filed with the County Auditor. Also, that the Chairman of the Township Board has a copy of the report that is available for inspection by any taxpayer of the township. The annual report data is to be sent to the State Board of Accounts, by the trustee, by January 30 (IC 5-11-1-4). State of Indiana SS: Lagrange I, William Pipher, Trustee of Bloomfield Township, Lagrange, Indiana, do solemnly affirm under the penalty of perjury that the preceding report is complete, true and correct; that the sum with which I am charged in this report are all of the sums received by me; and that the various items of expenditures credited have been fully paid in the sums stated; that such payments were made without express or implied agreement that any portion thereof shall be retained by or repaid to me or to any other person. I further affirm that a complete and detailed annual report, together with all accompanying vouchers showing the names of persons having been paid money by the township, have been filed as required by law in the office of the County Auditor, and that copies of such annual report are in custody of the Township Board and the State Board of Accounts. Said report is subject to inspection by any taxpayer of the township. ______________________________________ (sign) Bloomfield Township Trustee Telephone: (260) 463-3411 Date this report was published: _______________________ Subscribed and sworn (or affirmed) to before me, the Chairman of the Township Board of Bloomfield Township at its annual meeting, this _______ day of January , 2009. ______________________________________ (sign) Bloomfield Township Board Chairman OPTION 1 This report was received, accepted, and approved by the Township Board at its annual meeting, this ________ day of January, 2009. Bloomfield Township Board: ________________________________________________ (sign) ________________________________________________ (sign) ________________________________________________ (sign) OPTION 2 This report was received, accepted, and approved except for Part(s) _________by the following Township Board Member(s) at its annual meeting, this ________ day of January, 2009 ________________________________________________ (sign) ________________________________________________ (sign) ________________________________________________ (sign) Note: Option 1 to be used where the Township Board approves the annual report. Option 2 to be used where a member or all members of the Township Board disapproves part or all of the annual report. (DO NOT ADVERTISE) ANNUAL FINANCIAL REPORT -- TOWNSHIP: ____________________________ INDIANA TOWNSHIPS COUNTY: ______________________________ TOWNSHIP FORM 15 (REVISED 2008) ================================================================================== PART 10 - NOTE TO PUBLISHERS NOTE TO PUBLISHERS: Township Form 15 is prescribed by the State Board of Accounts in compliance with IC 36-6-4-13. All legal advertisements shall by set in solid type not larger than the type used in the regular reading matter of the newspaper, without any leads or other devices for increasing space. All such advertisements shall be headed by no more than two (2) lines, neither of which shall total more than four (4) solid lines of the type in which the body of the advertisement is set. NOTE TO TOWNSHIP TRUSTEE: IC 36-6-4-13 requires Township Form 15 be prepared for publication within four weeks after the third Tuesday following the first Monday in January. Publication is to be made ONE TIME ONLY in two (2) newspapers published in the township. If only one (1) newspaper is published in the township, then the notice shall be published in that newspaper and if another newspaper is published in the county and circulates within the township, in the other newspaper. If no newspaper is published in the township, then publication shall be made in a newspaper published in the county and that circulates within the township. Prescribed by the State Board of Accounts Form TA-7 (Revised 2005) Bloomfield Township, Lagrange TOWNSHIP ASSISTANCE STATISTICAL REPORT (IC 12-20-28-3) FOR THE PERIOD ENDING DECEMBER 31, 2008 1. TOTAL NUMBER OF REQUESTS FOR TOWNSHIP ASSISTANCE 290 2.(A) TOTAL NUMBER OF TOWNSHIP ASSISTANCE RECIPIENTS 54 2.(B) TOTAL NUMBER OF HOUSEHOLDS CONTAINING RECIPIENTS OF TOWNSHIP ASSISTANCE 28 2.(C)(i) TOTAL NUMBER OF CASE CONTACTS MADE WITH OR ON BEHALF OF RECIPIENTS OF TOWNSHIP ASSISTANCE 2.(C)(ii) TOTAL NUMBER OF CASE CONTACTS MADE WITH OR ON BEHALF OF MEMBERS OF A HOUSEHOLD RECEIVING TOWNSHIP ASSISTANCE 3. TOTAL VALUE OF BENEFITS PROVIDED TO RECIPIENTS OF TOWNSHIP ASSISTANCE 4. TOTAL VALUE OF BENEFITS PROVIDED THROUGH EFFORTS OF TOWNSHIP STAFF FROM SOURCES OTHER THAN TOWNSHIP FUNDS 0 0 $12,695.59 $0.00 5.(A) TOTAL NUMBER RECEIVING UTILITY ASSISTANCE - RECIPIENTS 19 5.(A)(i) TOTAL NUMBER RECEIVING UTILITY ASSISTANCE - HOUSEHOLDS 10 5.(B) TOTAL NUMBER OF RECIPIENTS ASSISTED BY TOWNSHIP STAFF IN RECEIVING UTILITY ASSISTANCE FROM SOURCES OTHER THAN TOWNSHIP FUNDS 6.(i) TOTAL VALUE OF BENEFITS PROVIDED FOR PAYMENT OF UTILITIES - TOWNSHIP 6.(ii) TOTAL VALUE OF BENEFITS PROVIDED FOR PAYMENT OF UTILITIES - NONTOWNSHIP SOURCES 6.(iii) TOTAL VALUE OF ALL BENEFITS PROVIDED FOR PAYMENT OF UTILITIES 0 $2,454.30 $0.00 $2,454.30 7.(A) TOTAL NUMBER RECEIVING HOUSING ASSISTANCE - RECIPIENTS 32 7(A)(i) TOTAL NUMBER RECEIVING HOUSING ASSISTANCE - HOUSEHOLDS 16 7.(B) TOTAL NUMBER OF RECIPIENTS ASSISTED BY TOWNSHIP STAFF IN RECEIVING HOUSING ASSISTANCE FROM SOURCES OTHER THAN TOWNSHIP FUNDS 8.(i) TOTAL VALUE OF BENEFITS PROVIDED FOR HOUSING ASSISTANCE - TOWNSHIP 8.(ii) TOTAL VALUE OF BENEFITS PROVIDED FOR HOUSING ASSISTANCE - NONTOWNSHIP SOURCES 8.(iii) TOTAL VALUE OF ALL BENEFITS PROVIDED FOR HOUSING ASSISTANCE 9.(A) TOTAL NUMBER RECEIVING FOOD ASSISTANCE - RECIPIENTS 9.(A)(i) TOTAL NUMBER RECEIVING FOOD ASSISTANCE - HOUSEHOLDS 9.(B) TOTAL NUMBER OF RECIPIENTS ASSISTED BY TOWNSHIP STAFF IN RECEIVING FOOD ASSISTANCE FROM SOURCES OTHER THAN TOWNSHIP FUNDS 10.(i) TOTAL VALUE PROVIDED FOR FOOD ASSISTANCE - TOWNSHIP 10.(ii) TOTAL VALUE PROVIDED FOR FOOD ASSISTANCE - NONTOWNSHIP SOURCES 10.(iii) TOTAL VALUE ALL FOOD ASSISTANCE PROVIDED 0 $8,070.00 $0.00 $8,070.00 0 130 0 $1,000.00 $0.00 $1,000.00 Prescribed by the State Board of Accounts Form TA-7 (Revised 2005) Bloomfield Township, Lagrange TOWNSHIP ASSISTANCE STATISTICAL REPORT (IC 12-20-28-3) FOR THE PERIOD ENDING DECEMBER 31, 2008 (Continued) 11.(A) TOTAL NUMBER PROVIDED HEALTH CARE - RECIPIENTS 4 11.(A)(i) TOTAL NUMBER PROVIDED HEALTH CARE - HOUSEHOLDS 3 11.(B) NUMBER OF RECIPIENTS ASSISTED BY TOWNSHIP STAFF IN RECEIVING HEALTH CARE ASSISTANCE FROM SOURCES OTHER THAN TOWNSHIP FUNDS 12.(i) TOTAL VALUE OF HEALTH CARE PROVIDED - TOWNSHIP SOURCES 12.(ii) TOTAL VALUE OF HEALTH CARE PROVIDED - NONTOWNSHIP SOURCES 12.(iii) TOTAL VALUE OF ALL OF HEALTH CARE PROVIDED 13. TOTAL NUMBER OF FUNERALS, BURIALS AND CREMATIONS 0 $1,171.29 $0.00 $1,171.29 1 14.(A) TOTAL ACTUAL VALUE OF FUNERALS, BURIALS AND CREMATIONS $1,000.00 14.(B)(i) TOTAL PAID BY TOWNSHIP FUNDS FOR FUNERALS, BURIALS AND CREMATIONS $1,000.00 14.(B)(ii) DIFFERENCE BETWEEN ACTUAL VALUE AND AMOUNT PAID BY TOWNSHIP FUNDS FOR FUNERALS, BURIALS AND CREMATIONS 15.(A) TOTAL NUMBER OF NIGHTS OF EMERGENCY SHELTER PROVIDED TO THE HOMELESS 15.(B) TOTAL NUMBER OF NIGHTS OF EMERGENCY SHELTER PROVIDED TO THE HOMELESS THROUGH EFFORTS OF TOWNSHIP STAFF FROM SOURCES OTHER THAN TOWNSHIP FUNDS $0.00 0 0 15.(C)(i) TOTAL VALUE OF EMERGENCY SHELTER FOR HOMELESS INDIVIDUALS - TOWNSHIP $0.00 15.(C)(ii) TOTAL VALUE OF EMERGENCY SHELTER FOR HOMELESS INDIVIDUALS - NONTOWNSHIP SOURCES $0.00 15.(C)(iii) TOTAL VALUE OF ALL EMERGENCY SHELTER PROVIDED FOR HOMELESS INDIVIDUALS $0.00 16.(A) TOTAL NUMBER OF REFFERALS OF TOWNSHIP ASSISTANCE APPLICANTS TO OTHER PROGRAMS 16.(B) TOTAL VALUE OF TOWNSHIP SERVICES IN MAKING REFERRALS TO OTHER PROGRAMS 17. TOTAL NUMBER OF TRAINING PROGRAMS OR JOB PLACEMENTS FOUND FOR TOWNSHIP ASSISTANCE RECIPIENTS WITH ASSISTANCE OF TOWNSHIP TRUSTEE 18. NUMBER OF HOURS SPENT BY TOWNSHIP ASSISTANCE RECIPIENTS AT WORKFARE 130 $0.00 0 0 19.(i) TOTAL VALUE OF SERVICES PROVIDED BY WORKFARE TO THE TOWNSHIP $0.00 19.(ii) TOTAL VALUE OF SERVICES PROVIDED BY WORKFARE TO OTHER AGENCIES $0.00 19.(iii) TOTAL VALUE OF ALL SERVICES PROVIDED BY WORKFARE $0.00 20.(A) TOTAL AMOUNT OF REIMBURSEMENT FOR ASSISTANCE RECEIVED FROM RECIPIENTS $0.00 20.(B) TOTAL AMOUNT OF REIMBURSEMENT FOR ASSISTANCE RECEIVED FROM MEMBERS OF RECIPIENTS' HOUSEHOLDS 20.(C) TOTAL AMOUNT OF REIMBURSEMENT FOR ASSISTANCE RECEIVED FROM RECIPIENTS' ESTATES 21. TOTAL AMOUNT OF REIMBURSEMENT FOR ASSISTANCE RECEIVED FROM MEDICAL PROGRAMS UNDER IC 12-20-16-2(e) 22.(A) TOTAL NUMBER OF INDIVIDUALS ASSISTED THROUGH A REPRESENTATIVE PAYEE PROGRAM 22.(B) TOTAL AMOUNT OF FUNDS PROCESSED THROUGH THE REPRESENTATIVE PAYEE PROGRAM THAT ARE NOT TOWNSHIP FUNDS $0.00 $0.00 $325.52 0 $0.00 Prescribed by the State Board of Accounts Form TA-7 (Revised 2005) Bloomfield Township, Lagrange TOWNSHIP ASSISTANCE STATISTICAL REPORT (IC 12-20-28-3) FOR THE PERIOD ENDING DECEMBER 31, 2008 (Continued) 23.(A) TOTAL NUMBER OF INDIVIDUALS ASSISTED THROUGH SPECIAL NONTRADITIONAL PROGRAMS PROVIDED THROUGH THE TOWNSHIP WITHOUT THE EXPENDITURE OF TOWNSHIP FUNDS 23.(B) TOTAL AMOUNT OF NONTOWNSHIP FUNDS USED TO PROVIDE THE SPECIAL NONTRADITIONAL PROGRAMS 24.(A)(i) TOTAL NUMBER OF HOURS AN INVESTIGATOR OF TOWNSHIP ASSISTANCE SPENDS ON CASE MANAGEMENT SERVICES - RECIPIENTS 24.(A)(ii) TOTAL NUMBER OF HOURS AN INVESTIGATOR OF TOWNSHIP ASSISTANCE SPENDS ON CASE MANAGEMENT SERVICES - HOUSEHOLDS 24.(B) TOTAL VALUE OF CASE MANAGEMENT SERVICES PROVIDED 25. TOTAL NUMBER OF HOUSING INSPECTIONS PERFORMED BY THE TOWNSHIP 0 $0.00 0 0 $0.00 0 DATE_______________ TRUSTEE'S SIGNATURE_______________________________________ The State Board of Accounts is of the audit position, with the concurrence of the Attorney for the Township Trustees Association, the following procedures should be followed for a consistent compilation and completion of Township Assistance Form TA-7. When completing the form please keep in mind reconcilement or cross-checking cannot, necessarily, be achieved; i.e., Total Value of Benefits Provided Township Assistance Recipients (Item 3), will not necessarily be the summation of Total Value of Benefits Provided for Utilities (Item 5); Total Value of Benefits Provided for Housing Assistance (Item 7); Total Value of Food Assistance Provided (Item 9); and, Total Value of Health Care Provided (Item 11); because IC 12-20-28-3 does not specifically require separate reporting of certain Township Assistance provided by townships; i.e., clothing, household supplies, transportation, etc. (TOWNSHIP FORM 15) ANNUAL FINANCIAL REPORT UNIT NAME: COUNTY: PART 12 - FINANCIAL ASSISTANCE TO NONGOVERNMENTAL ENTITIES FOR THE FISCAL YEAR ENDING 2008 Bloomfield Township Lagrange Federal ID Name of Operating Officer Phone Number Description of Funding Name Address County of Operation Clothes Food Basket LaGrange LaGrange, IN 4-6761 ID: PAGE: Clothes Food 44-2-1 1 Amount $1,000.00
Source Exif Data:
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