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<br />Summary of Shared Monies Spent: Enter on lines a-m the total amount spent for each item listed. <br /> <br />: Total Spent on Other Law Enforcement Expenses: Enter on line j the total amount of expenses not listed in items <br />1 through i. Attach list of expenditures. <br /> <br />Total Transfer to Law Enforcement Agencies: Enter on line k the amounts transferred to other state and local law <br />~nforcement agencies. Attach list of recipients with their addresses and include amount of cash, property, and proceeds <br />transferred. Verify that the recipients have submitted a Federal Equitable Sharing Agreement to both the Departments of <br />Justice and the Treasury. <br /> <br />Total Permissible Use Transfers: Enter on line I the total of the amounts transferred to eligible non-law enforcement <br />1gencies and private groups. Attach list of recipients with their addresses, and direct expenditures made on behalf of the <br />~ligible agencies and groups. <br /> <br />Total ~pent on Matching Grants: Enter on line m amounts your agency spent to match grants.' <br /> <br />Law Enforcement Agency Head or Authorized Representative: The head of your law enforcement agency (or <br />the authorized representative) must sign and date the fonn. (Examples of law enforcement agency head or authorized <br />representative include the following: police chief, district attorney, sheriff, undersheriff, deputy chief, etc.) Name and <br />,ide of the signatory must be printed or typed. By signing the agreement, the head of the law enforcement agency (or the <br />luthorized representative) certifies that this report is an accurate accounting of funds received and spent by the law <br />~nforcement agency under the federal equitable sharing program during this reporting period. <br /> <br />Governing Body Head or Representative: The head of your governing bOdy (or the authorized repres~ntative) must <br />,ign and date the form. (Examples of governing body head or authorized representative include the following: city <br />nanager, county executive, mayor, county judge, etc.) Name and title of the signatory must be printed or typed. By <br />;igning the certification, the head of the governing body (or the authorized representative) certifies that this report is an <br />lccurate accounting of funds received and spent by the law enforcement agency under the federal equital?le sharing <br />)rogram during this reporting period. For purposes of this fonn, a governing body is an institution or organization that has <br />lppropriations authority-that is, the agency that gives your agency its budget-over the state or local law enforcement <br />1gency. A law enforcement official should not sign for the governing body unless he/she has appropriations authority. <br /> <br />Wail the Federal Annual Certification Report to: <br />U.S. Department of Justice/ACA Program <br />10th and Constitution A venues, NW <br />Criminal Division! AFMLS <br />Bond Building, Tenth Floor <br />Washington, D.C. 20530 <br />Fax: (202) 616-1344 <br /> <br />Executive Office for Asset Forfeiture <br />U.S. Department of the Treasury <br />740 15th Street, NW, Suite 700 <br />Washington, D.C. 20220 <br />E-mail address: treas.aca@teoaf.treas.gov <br />Fax: (202) 622-9610 <br /> <br />-\ copy of the report must also be sent to the U.S. Attorney in the district in which the recipient agency is <br />ocated. <br /> <br />M<lrch Z(){lZ <br />