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<br />Federal Annual Certification Report <br />Instructions <br /> <br />(Please retain these instructions for your records.) <br /> <br />Law Enforcement Agency: Enter the complete name of your state or local law enforcement agency. Check the <br />appropriate box to indicate type of agency. Acronyms should be spelled out. If a task force, provide a list of member <br />agencies, addresses, and amounts transferred. <br /> <br />Contact Person: Enter the name of the person who can provide additional information on the certification report. <br /> <br />E-mail Address: Enter the e-mail address of the contact person or the e-mail address of the agency. <br /> <br />Mailing Address: Enter your agency's complete mailing address (number, street, city/town, state, and zip code). <br /> <br />Telephone Number: Enter the phone number of the contact person, including area code and extension, if any. <br /> <br />Fax Number: Enter your agency's fax number including area code. <br /> <br />Agency Fiscal Year Ends on: Enter the ending date (month/day/year) of your agency's fiscal year, e.g., 6/30/02. <br /> <br />NCIC/ORlnracking No.: Enter your valid FBI-issued National Crime Information Center (NCIC)/ORI code-e.g., <br />CAOOOOOOO-or tracking number assigned by AFMLS. <br /> <br />Beginning Sharing Fund Balance: Enter on line 1 the amount inyour federal forfeiture fund account a! the beginning <br />of your fiscal year. Separate Justice from .Treasury fund balances. Include under Justice fund: .shared cash and/or <br />proceeds received from: DEA, FBI, INS, U.S. Attorney's Office, u..S. Postal Inspection Service, FDA, and USDA. <br />Include under Treasuryfund: shared cash and/or proceeds received from: the IRS, ATF, U.S. Secret Service, and U.S. <br />Customs Service. <br /> <br />Federal Sharing Funds Received: Enter on line 2 the total amount of shared cash and/or proceeds received from the <br />federal equitable sharing programs. For example, if your fiscal year ends 6/30/02, include all sharing funds received from <br />7/1/01 through 6/30/02. Separate Justice funds from Treasury funds. <br /> <br />Transfers FrDm Other Law Enforcement Agencies: Enter on line 3 amounts received from other law enforcement <br />agencies. If your agency received $10,000 from a task force, enter this amount on line 3. Attach a list oflaw enforcement <br />agenCIes. <br /> <br />Other Income: Enter on line 4 the proceeds from the sale of shared property or any amounts returned to your forfeiture <br />fund account, e.g., received $10,000 for the sale of a car placed in official use. <br /> <br />Interest Income Accrued: Enter on line 5 the interest earned on your federal forfeiture fund account during your fiscal <br />year. Account for Justice and Treasury interest income separately. Check box if the funds are in a non-interest-bearing <br />account. <br /> <br />Total Equitable Sharing Funds: Add the beginning sharing fund balance (line 1), the sharing funds received (line 2), <br />sharing funds received from other law enforcement agencies (line 3), other income (line 4), and interest income (line 5). <br />Enter on line 6 the total amount. <br /> <br />Federal Sharing Funds Spent: Add items a through m. Enter the total amount on line 7. <br /> <br />Equitable Sharing Fund Balance: Subtract the sharing funds spent (line 7) from the total of equitable sharing fund <br />(line 6). Enter on line 8 the ending balance. <br /> <br />Appraised Value of Other Assets: Enter on line 8 the fair market value of any property received, e.g., if the fair <br />market value ofa car is $10,000, then enter $10,000 on line 8. Note: When the car is sold, the proceeds of the sale must <br />be entered on line 4 (other income) in the year sold. <br />