Laserfiche WebLink
<br />~ <br /> <br />I" GUG' a. "'. II nAQ. ""\;;0. .....va..."'.. . ~"tI~' " <br />this Annua' Certification Report must be submitted within 60 days after the close of your fiscal year to both agencies: <br /> <br />U.S. Department o( Justlce/ACA Program <br />10th and Constitution Avenues. NW <br />Criminal DivisionlAFMLS <br />Bond Building. Tenth Floor <br />Washington. DC 20530 <br />Fax: (202) 616-1344 <br /> <br />u.s. Department o( the Treasury <br />Executive Office lor Asset Forfeiture <br />740 15th Street. NW. Suite 700 <br />Washington, D.C. 20220 <br />E-mail address: treas.aca@teoal.treas.gov <br />Fax: (202) 622.9610 <br /> <br />Law Enforcement Agency: <br />o Police Department 0 ShenlT's Office/Department <br /> <br /> <br />o Prosecutor's Office <br /> <br />C' Task Force' <br /> <br />Contact Person: <br /> <br />E-mail Address: <br /> <br />Mailing ~dress: <br /> <br />o Other <br /> <br />(Street) <br /> <br />(City) <br /> <br />Telephone Number: L-) <br /> <br />Fax Number: l.:.--) <br /> <br />Agency Fiscal Year Ends on: <br /> <br />NCIC/ORlITracking No.: <br /> <br />(MonthlDaylYcar) <br /> <br />(State) <br /> <br />(Zip Code) <br /> <br />Summary of Equitable Sharing Activity <br />(Fiscal Vear Ending ) <br /> <br />I. Beginning Equitable Sharing Fund Balance <br />2. Federal Sharing Funds Received <br />3. Transfers From Other Law Enforcement Agencies (attach list) <br />4. Other Income <br />S. Interest Income Accrued (0 check ifnon-interest-bearing account) <br />6. Total Equitable Sharing Funds (total of lines I .5) <br />7. Federal Sharing Funds Spent (total of lines a - m) . <br />8. Equitable Sharing Fund Balance (subtract line 7 from line 6) <br />9. Appraised Value of Other Assets Received <br /> <br />Summary of Shared Monies Spent <br /> <br />a. Total spent on salaries for new, temporary, not to exceed I-year employees <br />b. Ovenime <br />c. Total spent on informant and "buy money" <br />d. Total spent on travel and training <br />e. Total spent on communications and computers <br />f. Total spent on firearms and weapons <br />g. Total spent on body armor and protective gear <br />h. Total spent on electronic surveillance equipment <br />I. Total spent on building and improvements <br />j. Total spent on other law enforcement expenses (attach list) <br />k. Total transfers to other law enforcement agencies (attach list ofrecipients) <br />I. Total permissible use transfers (attach list of recipients) <br />m. Total spent on matching grants (attach list) <br /> <br />Justice Funds <br />S <br />S <br />S <br />S <br />S <br />$ <br />$( <br />S <br />S <br /> <br />S <br />$ <br />S <br />S <br />S <br />S <br />S <br />S <br />$ <br />S <br />$ <br />S <br />$ <br /> <br />Treasury Funds <br />$ <br />$ <br />S <br />$ <br />S <br />$ <br />$ ( <br />$ <br />$ <br /> <br />$ <br />S <br />S <br />S <br />$ <br />S <br />$ <br />S <br />S <br />S <br />S <br />S <br /> <br />Under the penalty of perjury, the undersigned hereby certify that the infonnation in this report is an accurate accounting of funds received and <br />spent by the law enforcement agency under the federal equitable sharing program during this reporting period. <br /> <br />Name (Print or Type) Date <br />Law Enforcement Agency Head or Authorized Representative <br /> <br />Name (Print or Type) Date <br />Governing Body Head or Authorized Representative <br /> <br />(Signature) <br /> <br />(Signature) <br /> <br />Title (Print or Type) <br /> <br />Title (Print or Type) <br /> <br />I Attach list of member agencies with their addresses and indicatc.lead agency. <br /> <br />This form is subject to the Freedom of Information Act and may be released to requests under 5 U.S.C. S 552. <br /> <br />M~rch 2002 <br />