Report CS2171 2008bloomfieldannualreport

User Manual: CS2171

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COUNTY:
Lagrange
ID: 44-2-1
(State Board of Accounts USE ONLY)
FILED IN THE COUNTY AUDITOR'S OFFICE ON:
01/20/2009
TITLE:
William Pipher
ADDRESS: 818 N. Detroit Street CITY: LaGrange
TELEPHONE (BETWEEN THE HOURS OF 8:00 AM AND 5:00 PM): (260) 463-3411 ZIP: 46761-0000
FEDERAL IDENTIFICATION NUMBER:
35-6003092
CONTENTS:
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
PRINTED NAME OF OFFICIAL:
Bloomfield Township
UNIT NAME:
Township Trustee
TOWNSHIP TRUSTEES ANNUAL REPORT TO:
THE TOWNSHIP BOARD
THE COUNTY AUDITOR
THE STATE BOARD OF ACCOUNTS
THE U.S. BUREAU OF CENSUS
TOWNSHIP: Bloomfield Township
COUNTY: Lagrange
FOR THE FISCAL YEAR ENDED 2008
ANNUAL TOWNSHIP FINANCIAL REPORT
PRESCRIBED BY
THE STATE BOARD OF ACCOUNTS
STATE OF INDIANA
STATE BOARD OF ACCOUNTS
302 W. WASHINGTON ST., E418
INDIANAPOLIS, IN 46204-2765
TELEPHONE: (317) 232-2513
TOWNSHIP FORM 15 (REVISED 2008)
FOR THE FISCAL YEAR THAT ENDED 2008
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
FUND TYPE: SPECIAL REVENUE
11 FIREFIGHTING $10,316.58 $6,338.82 $12,853.07 $3,802.33 $50,000.00 $53,802.33
61 RAINY DAY $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
FUND TYPE: CAPITAL PROJECTS
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
FUND TYPE: AGENCY
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
Section II
Less:
Investment Sales $0.00
Investment Purchases $50,000.00
Transfers In $272.58
Transfers Out $272.58
Net Receipts and Disbursements $133,026.64 $151,540.60
(TOWNSHIP FORM 15) ANNUAL FINANCIAL REPORT
PART 1 - STATEMENT OF RECEIPTS, DISBURSEMENTS, CASH BALANCES, AND INVESTMENT BALANCES
COUNTY:
1PAGE:FOR THE FISCAL YEAR ENDING 2008
UNIT NAME:
Lagrange
44-2-1ID: Bloomfield Township
Fund Balances Receipts Disbursements Fund Balances
Beginning Cash Ending Cash Investments Investments
Total Cash and
Funds 01/01/2008 2008 2008 at 12/31/2008 12/31/2008 at 12/31/2008
Section I
1 GENERAL Fund:
AUTO AND AIRCRAFT EXCISE TAX $2,346.64
COMMERCIAL VEHICLE EXCISE TAX $562.76
FINANCIAL INSTITUTION TAX $380.00
GENERAL PROPERTY TAXES $28,155.14
PROPERTY TAX REPLACEMENT CREDIT (LOCAL OPTION TAX) $4,077.00
Total for: TAXES $35,521.54
INTEREST EARNED $2,540.24
MISCELLANEOUS REVENUE-OTHER $5.18
Total for: MISCELLANEOUS $2,545.42
REFUNDS-OTHER $2,367.82
TRANSFER OF FUNDS-OTHER $272.58
Total for: OTHER FINANCING SOURCES $2,640.40
TOTAL RECEIPTS FOR 1 GENERAL $40,707.36
11 FIREFIGHTING Fund:
AUTO AND AIRCRAFT EXCISE TAX $370.68
COMMERCIAL VEHICLE EXCISE TAX $13.84
FINANCIAL INSTITUTION TAX $7.00
GENERAL PROPERTY TAXES $4,169.45
Total for: TAXES $4,560.97
INTEREST EARNED $1,777.85
Total for: MISCELLANEOUS $1,777.85
TOTAL RECEIPTS FOR 11 FIREFIGHTING $6,338.82
61 RAINY DAY Fund:
CERTIFIED SHARES (LOCAL OPTION TAX) $4,456.17
Total for: TAXES $4,456.17
TOTAL RECEIPTS FOR 61 RAINY DAY $4,456.17
81 TOWNSHIP ASSISTANCE Fund:
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 PAGE: 1
PART 2 - RECEIPTS COUNTY: Lagrange
FOR THE FISCAL YEAR ENDING 2008
Amount
Title
Bloomfield Township UNIT
16 CUMULATIVE FIRE Fund:
AUTO AND AIRCRAFT EXCISE TAX $1,663.55
CERTIFIED SHARES (LOCAL OPTION TAX) $36,130.00
COMMERCIAL VEHICLE EXCISE TAX $62.16
FINANCIAL INSTITUTION TAX $29.00
GENERAL PROPERTY TAXES $18,711.67
Total for: TAXES $56,596.38
INTEREST EARNED $5,944.25
Total for: MISCELLANEOUS $5,944.25
TOTAL RECEIPTS FOR 16 CUMULATIVE FIRE $62,540.63
Total Receipts: $133,299.22
(TOWNSHIP FORM 15) ANNUAL FINANCIAL REPORT ID: 44-2-1 PAGE: 2
PART 2 - RECEIPTS COUNTY: Lagrange
FOR THE FISCAL YEAR ENDING 2008
Amount
Title
Bloomfield Township UNIT
Fund: 1 GENERAL
Dept: TWP FUND-GENERAL GOVERNMENT
PERSONAL SERVICES $53,807.77
SUPPLIES $960.19
OTHER SERVICES AND CHARGES $13,088.38
CAPITAL OUTLAY $139.98
TOTAL $67,996.32
TOTAL GENERAL $67,996.32
SUPPLIES
OTHER SERVICES AND CHARGES
CAPITAL OUTLAY
OTHER DISBURSEMENTS
TRANSFER OF FUNDS
PURCHASE OF INVESTMENTS
MEDICAL, HOSPITAL, AND BURIAL
$53,807.77
$960.19
$13,088.38
$139.98
$0.00
$0.00
$0.00
$0.00
PERSONAL SERVICES
BY OBJECT FOR GENERAL
Fund: 81 TOWNSHIP ASSISTANCE
Dept: TOWNSHIP ASSISTANCE ADMINISTRATION
PERSONAL SERVICES $4,229.50
OTHER SERVICES AND CHARGES $3,612.98
TOTAL $7,842.48
Dept: TOWNSHIP ASSISTANCE DIRECT ASSISTAN
MEDICAL, HOSPITAL, AND BURIAL $2,171.29
TOTAL $2,171.29
Dept: TOWNSHIP ASSISTANCE OTHER ASSISTANC
OTHER DISBURSEMENTS $14,485.71
TOTAL $14,485.71
TOTAL TOWNSHIP ASSISTANCE $24,499.48
SUPPLIES
OTHER SERVICES AND CHARGES
CAPITAL OUTLAY
OTHER DISBURSEMENTS
TRANSFER OF FUNDS
PURCHASE OF INVESTMENTS
MEDICAL, HOSPITAL, AND BURIAL
$4,229.50
$0.00
$3,612.98
$0.00
$14,485.71
$0.00
$0.00
$2,171.29
PERSONAL SERVICES
BY OBJECT FOR TOWNSHIP ASSISTANCE
PART 3A, Page 1- DISBURSEMENTS
FOR THE FISCAL YEAR ENDING 2008
(TOWNSHIP FORM 15) ANNUAL FINANCIAL REPORT
COUNTY:
UNIT NAME:
ID:
Bloomfield Township
Lagrange
44-2-1 PAGE: 1
Fund: 11 FIREFIGHTING
OTHER SERVICES AND CHARGES $12,853.07
TOTAL $12,853.07
Fund: 16 CUMULATIVE FIRE
CAPITAL OUTLAY $46,191.73
PURCHASE OF INVESTMENTS $50,000.00
TOTAL $96,191.73
Fund: 91 LEVY EXCESS AGENCY
TRANSFER OF FUNDS $272.58
TOTAL $272.58
$109,317.38TOTAL:
PART 3A, Page 2- DISBURSEMENTS
FOR THE FISCAL YEAR ENDING 2008
(TOWNSHIP FORM 15) ANNUAL FINANCIAL REPORT
COUNTY:
UNIT NAME:
ID:
Bloomfield Township
Lagrange
44-2-1 PAGE: 1
Fund: 1 GENERAL
Dept: TWP FUND-GENERAL GOVERNMENT
Object: PERSONAL SERVICES
Amount
$378.00
To Whom Paid:
Bowen, Steven
$900.00Connelly, Allen
$522.00Elliott II, Robert
$2,711.88Farmers State Bank
$1,740.37Group Administrators
$13,218.00LaGrange County
$900.00Merrifield, Patricia
$1,687.52P.E.R.F.
$13,000.00Pipher, Susan C.
$18,750.00Pipher, William L.
TOTAL PERSONAL SERVICES $53,807.77
Object: SUPPLIES
$189.00Postmaster
$754.86Staples
$16.33Wal-Mart
TOTAL SUPPLIES $960.19
Object: OTHER SERVICES AND CHARGES
$224.14Auto Owners
$3,200.00Boggs Pro Lawn Service, Inc.
$110.00C&C Law Enforcement Support
$1,948.00Combined Agency
$625.00Data Systems
$1,000.00Embarq
$4,800.00LaGrange Chiropractic Offices
$20.00LaGrange County Trustees Assoc
$1,031.04LaGrange Publishing Co.
$130.20Verizon Wireless
TOTAL OTHER SERVICES AND CHARGES $13,088.38
Object: CAPITAL OUTLAY
$139.98Staples
TOTAL CAPITAL OUTLAY $139.98
TOTAL $67,996.32
Fund: 11 FIREFIGHTING
Dept: FIREFIGHTING
Object: OTHER SERVICES AND CHARGES
$2,853.075 Alarm Fire & Safety Equip.
$10,000.00Town of LaGrange
TOTAL OTHER SERVICES AND CHARGES $12,853.07
PART 3B- DISBURSEMENTS
FOR THE FISCAL YEAR ENDING 2008
(TOWNSHIP FORM 15) ANNUAL FINANCIAL REPORT
COUNTY:
UNIT NAME:
ID:
Bloomfield Township
Lagrange
44-2-1 PAGE: 1
TOTAL $12,853.07
Fund: 81 TOWNSHIP ASSISTANCE
Dept: TOWNSHIP ASSISTANCE ADMINISTRATION
Object: PERSONAL SERVICES
Amount
$229.50
To Whom Paid:
Farmers State Bank
$4,000.00Pipher, Susan C.
TOTAL PERSONAL SERVICES $4,229.50
Object: OTHER SERVICES AND CHARGES
$625.00Data Systems
$250.00Eberhard & Gastineau
$1,200.00LaGrange Chiropractic Offices
$1,537.98Verizon Wireless
TOTAL OTHER SERVICES AND CHARGES $3,612.98
TOTAL $7,842.48
Dept: TOWNSHIP ASSISTANCE DIRECT ASSISTAN
Object: MEDICAL, HOSPITAL, AND BURIAL
$1,000.00Carney-Frost Funeral Home
$1,171.29Millers Pharmacy
TOTAL MEDICAL, HOSPITAL, AND BURIAL $2,171.29
TOTAL $2,171.29
Dept: TOWNSHIP ASSISTANCE OTHER ASSISTANC
Object: OTHER DISBURSEMENTS
$700.00CS Investment
$1,000.00Clothes & Food Basket
$375.00Country Place Apartments
$300.00Crabapple Cove
$725.00Hershberger, Joseph
$1,119.00Hicks, Jerry
$270.00L A Express
$167.00LaGrange Apartments
$1,254.94LaGrange County REMC
$295.00LaGrange Villas II
$630.22LaGrange Water & Sewer
$3,437.00Lightning Hills Apartments
$800.00Maples, Dale
$700.00Miller, Mary B.
$19.42Millers Super Valu
$330.00Morningstar, Dan
$888.13NIPSCO
$500.00Raatz, Brian
PART 3B- DISBURSEMENTS
FOR THE FISCAL YEAR ENDING 2008
(TOWNSHIP FORM 15) ANNUAL FINANCIAL REPORT
COUNTY:
UNIT NAME:
ID:
Bloomfield Township
Lagrange
44-2-1 PAGE: 2
Object: OTHER DISBURSEMENTS
Amount
$550.00
To Whom Paid:
Shaffer, Russell
$425.00Smith, Tia
TOTAL OTHER DISBURSEMENTS $14,485.71
TOTAL $14,485.71
Fund: 16 CUMULATIVE FIRE
Dept: CUMULATIVE FIRE
Object: CAPITAL OUTLAY
$44,352.75Danko Emergency Equipment Co.
$1,838.98Town of LaGrange
TOTAL CAPITAL OUTLAY $46,191.73
Object: PURCHASE OF INVESTMENTS
$50,000.00Farmers State Bank
TOTAL PURCHASE OF INVESTMENTS $50,000.00
TOTAL $96,191.73
Fund: 91 LEVY EXCESS AGENCY
Dept: LEVY EXCESS AGENCY
Object: TRANSFER OF FUNDS
$272.58Bloomfield Township
TOTAL TRANSFER OF FUNDS $272.58
TOTAL $272.58
$201,813.18TOTAL:
PART 3B- DISBURSEMENTS
FOR THE FISCAL YEAR ENDING 2008
(TOWNSHIP FORM 15) ANNUAL FINANCIAL REPORT
COUNTY:
UNIT NAME:
ID:
Bloomfield Township
Lagrange
44-2-1 PAGE: 3
CASH
Purchase Date Fund Name Description Serial No./Acct. No. Investment Balance, Jan 1 Maturity Date Interest Rate Purchase Cost
CHECKING ACCOUNT 3598027 $98,080.25
Total CASH: $98,080.25
INVESTMENTS
Purchase Date Fund Name Description Serial No./Acct. No. Investment Balance, Jan 1 Maturity Date Interest Rate Purchase Cost
07/09/2008 1 GENERAL CERTIFICATE OF DEPOSIT 1002785 $50,000.00 07/09/2009 2.90 $50,000.00
Total by Fund: $50,000.00
07/09/2008 11 FIREFIGHTING CERTIFICATE OF DEPOSIT 1002786 $50,000.00 07/09/2009 2.90 $50,000.00
Total by Fund: $50,000.00
01/16/2008 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
PART 4 - CASH AND INVESTMENTS
COUNTY:
1PAGE:
FOR THE FISCAL YEAR ENDING 2008
UNIT NAME:
Lagrange
44-2-1ID: Bloomfield Township
(TOWNSHIP FORM 15) ANNUAL FINANCIAL REPORT
COUNTY:
1PAGE:
FOR THE FISCAL YEAR ENDING 2008
UNIT NAME:
Lagrange
44-2-1ID: Bloomfield Township
PART 5 - INDEBTEDNESS
OUTSTANDING 1-1- (BEGINNING YEAR)
PRINCIPAL ISSUED DURING YEAR
PRINCIPAL RETIRED DURING YEAR
INTEREST PAID DURING (FULL YEAR)
PRINCIPAL AND INTEREST DUE NEXT YEAR
PART 6 - INTERGOVERNMENTAL EXPENDITURES OF THE EXPENDITURES REPORTED IN PART 3, HOW MUCH WAS PAID TO
OTHER GOVERNMENTAL UNITS FOR:
FIRE PROTECTION $11,838.98
TOTAL PAID TO LOCAL GOVERNMENTS $11,838.98
TOTAL PAID TO LOCAL AND STATE GOVERNMENTS $11,838.98
OUTSTANDING 12-31- (ENDING YEAR)
CFDA
Number Federal Title Agency Award Amount Fund Title Receipts Disbursements
(TOWNSHIP FORM 15) ANNUAL FINANCIAL REPORT
PART 7 - STATEMENT OF FEDERAL GRANT RECEIPTS, DISBURSEMENTS AND BALANCES
COUNTY:
1PAGE:
FOR THE FISCAL YEAR ENDING 2008
UNIT NAME:
Lagrange
44-2-1ID: Bloomfield Township
Grant
Number Project Name State Agency Award Amount Fund Title Receipts Disbursements
(TOWNSHIP FORM 15) ANNUAL FINANCIAL
PART 8 - STATEMENT OF STATE GRANT RECEIPTS, DISBURSEMENTS AND BALANCES
COUNTY:
1PAGE:
FOR THE FISCAL YEAR ENDING 2008
UNIT NAME:
Lagrange
44-2-1ID: Bloomfield Township
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).
PART 9 - CERTIFICATION
State of Indiana
SS:
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.
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)
______________________________________ (sign)
Lagrange
I, William Pipher, Trustee of Bloomfield Township, Lagrange, Indiana,
ANNUAL FINANCIAL REPORT --
INDIANA TOWNSHIPS
TOWNSHIP FORM 15 (REVISED 2008)
TOWNSHIP: ____________________________
COUNTY: ______________________________
==================================================================================
PART 10 - 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 PUBLISHERS:
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.
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 0
2.(C)(ii) TOTAL NUMBER OF CASE CONTACTS MADE WITH OR ON BEHALF OF MEMBERS OF A HOUSEHOLD
RECEIVING TOWNSHIP ASSISTANCE 0
3. TOTAL VALUE OF BENEFITS PROVIDED TO RECIPIENTS OF TOWNSHIP ASSISTANCE $12,695.59
4. TOTAL VALUE OF BENEFITS PROVIDED THROUGH EFFORTS OF TOWNSHIP STAFF FROM SOURCES OTHER
THAN TOWNSHIP FUNDS $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 0
6.(i) TOTAL VALUE OF BENEFITS PROVIDED FOR PAYMENT OF UTILITIES - TOWNSHIP $2,454.30
6.(ii) TOTAL VALUE OF BENEFITS PROVIDED FOR PAYMENT OF UTILITIES - NONTOWNSHIP SOURCES $0.00
6.(iii) TOTAL VALUE OF ALL BENEFITS PROVIDED FOR PAYMENT OF UTILITIES $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 0
8.(i) TOTAL VALUE OF BENEFITS PROVIDED FOR HOUSING ASSISTANCE - TOWNSHIP $8,070.00
8.(ii) TOTAL VALUE OF BENEFITS PROVIDED FOR HOUSING ASSISTANCE - NONTOWNSHIP SOURCES $0.00
8.(iii) TOTAL VALUE OF ALL BENEFITS PROVIDED FOR HOUSING ASSISTANCE $8,070.00
9.(A) TOTAL NUMBER RECEIVING FOOD ASSISTANCE - RECIPIENTS 0
9.(A)(i) TOTAL NUMBER RECEIVING FOOD ASSISTANCE - HOUSEHOLDS 130
9.(B) TOTAL NUMBER OF RECIPIENTS ASSISTED BY TOWNSHIP STAFF IN RECEIVING FOOD ASSISTANCE
FROM SOURCES OTHER THAN TOWNSHIP FUNDS 0
10.(i) TOTAL VALUE PROVIDED FOR FOOD ASSISTANCE - TOWNSHIP $1,000.00
10.(ii) TOTAL VALUE PROVIDED FOR FOOD ASSISTANCE - NONTOWNSHIP SOURCES $0.00
10.(iii) TOTAL VALUE ALL FOOD ASSISTANCE PROVIDED $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
11.(A) TOTAL NUMBER PROVIDED HEALTH CARE - RECIPIENTS 4
11.(A)(i) TOTAL NUMBER PROVIDED HEALTH CARE - HOUSEHOLDS 3
12.(iii) TOTAL VALUE OF ALL OF HEALTH CARE PROVIDED $1,171.29
13. TOTAL NUMBER OF FUNERALS, BURIALS AND CREMATIONS 1
14.(A) TOTAL ACTUAL VALUE OF FUNERALS, BURIALS AND CREMATIONS $1,000.00
15.(A) TOTAL NUMBER OF NIGHTS OF EMERGENCY SHELTER PROVIDED TO THE HOMELESS 0
11.(B) NUMBER OF RECIPIENTS ASSISTED BY TOWNSHIP STAFF IN RECEIVING HEALTH CARE ASSISTANCE
FROM SOURCES OTHER THAN TOWNSHIP FUNDS 0
12.(i) TOTAL VALUE OF HEALTH CARE PROVIDED - TOWNSHIP SOURCES $1,171.29
12.(ii) TOTAL VALUE OF HEALTH CARE PROVIDED - NONTOWNSHIP SOURCES $0.00
$1,000.00
14.(B)(i) TOTAL PAID BY TOWNSHIP FUNDS FOR FUNERALS, BURIALS AND CREMATIONS
14.(B)(ii) DIFFERENCE BETWEEN ACTUAL VALUE AND AMOUNT PAID BY TOWNSHIP FUNDS FOR FUNERALS,
BURIALS AND CREMATIONS $0.00
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
15.(C)(i) TOTAL VALUE OF EMERGENCY SHELTER FOR HOMELESS INDIVIDUALS - TOWNSHIP $0.00
$0.0015.(C)(ii) TOTAL VALUE OF EMERGENCY SHELTER FOR HOMELESS INDIVIDUALS - NONTOWNSHIP SOURCES
15.(C)(iii) TOTAL VALUE OF ALL EMERGENCY SHELTER PROVIDED FOR HOMELESS INDIVIDUALS $0.00
16.(B) TOTAL VALUE OF TOWNSHIP SERVICES IN MAKING REFERRALS TO OTHER PROGRAMS
16.(A) TOTAL NUMBER OF REFFERALS OF TOWNSHIP ASSISTANCE APPLICANTS TO OTHER PROGRAMS
$0.00
130
17. TOTAL NUMBER OF TRAINING PROGRAMS OR JOB PLACEMENTS FOUND FOR TOWNSHIP ASSISTANCE
RECIPIENTS WITH ASSISTANCE OF TOWNSHIP TRUSTEE 0
18. NUMBER OF HOURS SPENT BY TOWNSHIP ASSISTANCE RECIPIENTS AT WORKFARE
19.(i) TOTAL VALUE OF SERVICES PROVIDED BY WORKFARE TO THE TOWNSHIP
0
$0.00
$0.00
$0.00
19.(ii) TOTAL VALUE OF SERVICES PROVIDED BY WORKFARE TO OTHER AGENCIES
19.(iii) TOTAL VALUE OF ALL SERVICES PROVIDED BY WORKFARE
20.(A) TOTAL AMOUNT OF REIMBURSEMENT FOR ASSISTANCE RECEIVED FROM RECIPIENTS
20.(B) TOTAL AMOUNT OF REIMBURSEMENT FOR ASSISTANCE RECEIVED FROM MEMBERS OF RECIPIENTS'
HOUSEHOLDS
$0.00
$0.00
20.(C) TOTAL AMOUNT OF REIMBURSEMENT FOR ASSISTANCE RECEIVED FROM RECIPIENTS' ESTATES $0.00
21. TOTAL AMOUNT OF REIMBURSEMENT FOR ASSISTANCE RECEIVED FROM MEDICAL PROGRAMS UNDER
IC 12-20-16-2(e) $325.52
0
$0.00
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
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)
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.
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 $0.00
0
24.(A)(i) TOTAL NUMBER OF HOURS AN INVESTIGATOR OF TOWNSHIP ASSISTANCE SPENDS ON CASE
MANAGEMENT SERVICES - RECIPIENTS 0
24.(A)(ii) TOTAL NUMBER OF HOURS AN INVESTIGATOR OF TOWNSHIP ASSISTANCE SPENDS ON CASE
MANAGEMENT SERVICES - HOUSEHOLDS 0
24.(B) TOTAL VALUE OF CASE MANAGEMENT SERVICES PROVIDED $0.00
25. TOTAL NUMBER OF HOUSING INSPECTIONS PERFORMED BY THE TOWNSHIP 0
Prescribed by the State Board of Accounts Form TA-7 (Revised 2005)
(Continued)
FOR THE PERIOD ENDING DECEMBER 31, 2008
TOWNSHIP ASSISTANCE STATISTICAL REPORT (IC 12-20-28-3)
Bloomfield Township, Lagrange
Federal ID Name Address County of Operation Name of Operating Officer Phone Number Description of Funding Amount
Clothes Food
Basket LaGrange Clothes Food $1,000.00
LaGrange, IN 4-6761
(TOWNSHIP FORM 15) ANNUAL FINANCIAL REPORT
PART 12 - FINANCIAL ASSISTANCE TO NONGOVERNMENTAL ENTITIES
COUNTY:
1PAGE:
FOR THE FISCAL YEAR ENDING 2008
UNIT NAME:
Lagrange
44-2-1ID: Bloomfield Township

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