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