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O Unit ID and Name: 100031 Indian River Was Annual Financial Report filed electronically? State Use OnIV Yes fR No Initials Date Financial Officer Name: Jeffrey K Barran If yes Indicate method: AFR Tracked ■ Financial Officer Title: clerkofcircuitCourt j�(FTP (] Diskette Audit Tracked Mailing Address: 184025th Street Date completed Audit Report was received: 3 1 191 2004 Rev/Exp City Address: Ivero Beach Complete i Has the local governmental entity reported herein expended any funds received from the State of Florida after July 1, 2002, for State: FI newspaper, magazine, direct, mall, radio, television, or outdoor advertising in support of, or in opposition to, any candidate or issue appearing on the ballot?(Reference Section 78, Chapter 2002402, Laws of Florida. See memorandum dated August 59 2002 included in Zip Code: 32960-3394 this reporting package.) _YES ANO Email Address: Financial Condition Information Phone Number; 1 Amount of outstanding long-term debt: ( 7 7 2 ) 5 6 7 - 8 0 0 0 (As of the end of fiscal year ended 09/30/2003. The term "long-tern debt" means any agreement or series of agreements to pay Phone Extension: Fmoney, which, at inception, contemplate term of payment exceeding I year in duration) 11205 Contact Person's Name: 113dwin M. Fry, Jr. Have you experienced a financial emergency In fiscal year ended 20037 ❑® Yes XNo Contact's Phone Number: ( 772 ) 567 - 8000 If yes, have you complied with Section 218.503(2), Florida Statutes? Yes ❑® No (ie: Have you repotted a financial emergency if there has been one ?) Contact's Extension: F1205 Use separate page for response if needed. FAX Number: F—( 772 ) 770 - 5331 Mail Completed Forms and Required Attachments/Enclosures to State of Florida Department of Financial Services Certification Annual Local Government Financial Report Bureau otAccounting We the undersigned certify, to the best of our knowledge, that the Information reported FISCaI Year 2002-ZOOS 200 E. Gaines Street herein or submitted electronically Is accurate and complete. Caroline Ginn Tallahassee, Florida 32399-0354 Counties and Municipalities Only Name BCC Approved : 04 - 06 - 04 Enter the utility service tax rates for the following : Board of County Commissioners Chairman Title r , Electricity L�Cnv Telecommunications X Signature of Chairman of Go rnment Board (required) Water Q tCeL� ..V� �,eet 4YZ�t** %art : Jeffrey K . Berton Natural Gas Name Cable Vision Clerk of the Circuit Court Title Fuel Oil Propane X Signature Financial Officer (required) Other FORM DFS-Al-401 (Rev . 10/28/2003)