HomeMy WebLinkAbout2012-074 DRJ00218
Application for Revenue Sharing 2012 -2013 State Fiscal Year R. 03/12
( Chapter 218 , Part II Florida Statutes )
Ir,f �/
DEPARTMENT
Or REVENUE
Application deadline is June 30 , 2012 .2o I a • O 74
Mail completed original application to :
Department of Revenue
Revenue Accounting Subprocess
P . O . Box 6609
Tallahassee , FL 32314-6609
850 -617 -8586
REVENUEACCOUNTING@dor.state. fl . us
Please TYPE or PRINT
Name of County INDIAN RIVER
OR
Name of Municipality County
Telephone Number (772) 226- 1206
Fax Telephone Number (772 ) 770-5331
Mayor or Chairman of Governing Body Ory C . Wheeler, Chairman of the Board of County Commissioners
Chief Fiscal Officer effrey Barton , Clerk of the Circuit Court and Comptroller
E- mail Address halsey@clerk . indian - river. org
Official Mailing Address 1801 27th Street , Bldg . A , Vero Beach , FL , 32960
❑ Check here if the address represents a change from the previous application .
Federal Employer I . D . Number ( required for new participants only ) .
Please complete the questions below to determine your eligibility to participate in Revenue Sharing for this fiscal
year.
1 . Have you submitted your financial statements for fiscal year ending 09/30/ 10 to the Department of Financial Services
as required by s . 218 . 32 , F . S . ?
a Yes No
2 . Have you made provisions for annual postaudits of your financial accounts as provided by
s . 11 . 45 , F . S . ?
1Z Yes No
3/09/2012 9/30/2011
Date of Audit Report Fiscal Year-End
DRJ00218
R. 03/12
3 . Have you reported on your most recent financial statement revenues equivalent to three mills calculated based on Page
2
your 1973 taxable values ? This revenue should be net of debt service or special millages approved by the voters .
The revenue can be generated by a combination of ad valorem tax , utility tax , occupational license tax , or a payment
from the county as allowed by s . 125 . 01 , Florida Statutes .
ZYes F] No
4 . If you have a law enforcement department, answer the questions below: ( If you have a contracted or strictly
volunteer department, skip to question 5 )
(A) Have your law enforcement officers , as defined by s . 943 . 10 ( 1 ) , F . S . , met the qualifications for employment
as
established by the Criminal Justice Standards and Training Commission , and do you compensate them at an
annual salary rate of six thousand dollars ($6 , 000) or more ?
zYes ❑ No
(B ) Does the salary structure and salary plans for law enforcement officers meet the requirements of
Chapter 943 F . S . ?
ZYes No
5 . If you have a fire department, answer the questions below: ( If you have a contracted or strictly volunteer
department, skip to question 6)
(A) Have your firefighters , as defined by s . 633 . 30 ( 1 ) , F . S . , met the requirements stated in s . 633 . 34
, 633 . 35 , and
633 . 382 F . S .
Ix Yes F] No
( B ) Does your fire department employ any full -time firefighters , who currently have either a bachelor' s degree or
associate degree from a college or university which is applicable to fire department duties , if the degree is not a
requirement for their current position ?
zYes F No
( C ) If so , are these firefighters currently receiving supplemental compensation for those degrees ?
aYes F1 No
6 . Are dependent special districts budgeted separately from the general budget of your government ? Do they meet the
provisions for annual postaudit of their financial accounts in as provided by s . 11 . 45 ( 3 ) , F . S . ?
YesF] No 11Does Not Apply
7 . Have you met the requirements of s . 200 . 065 , F . S . , if applicable ? (The annual certification must be within 30
days of
adoption of an ordinance or resolution establishing a final property tax levy or , if no property tax is levied , not
later
than November 1 .
Ix
Yes ❑ No
The portion of revenue sharing funds which , according to Part II , Chapter 218 , F . S . , would otherwise be distributed
to a unit of local government which has not certified compliance or has otherwise failed to meet the requirements
of s . 200 . 065 , F . S . , shall be deposited in the General Revenue Fund for the 12 months following a determination
of
noncompliance by the department . )
DR400218
R. 03/12
Page 3
1 certify that all information is accurate and true to the best of my knowledge . I further certify that I will promptly
report to the Department of Revenue any changes in the above information . I also realize that failure to provide timely
information required , allows the Department to utilize the best information available . If no such information is available ,
the Department will take necessary action including disqualification , either partial or entire , and you will waive your
right to challenge the determination of the Department to your share of funds , if any , beyond your minimum entitlement ,
according to the privilege of receiving shared revenues from the Revenue Sharing Trust Funds .
Do you believe that you have complied with ALL eligibility requirements as listed above ?
Yes No
Z ❑
If the answer to question above is ( NO ) , please provide an attachment of the revenue necessary to meet your obligations
because of pledges or assignments or trusts entered into which obligated funds received from revenue sharing .
.MM
Signe : e ;!*v
° MMISsj"' " •,. Date :
Chief Fiscal Official ,.J�� • •.;9�'•
j
: U ; '
i
.� _a_..__ y ' •
Signed : • te : 05 /� 1 / 12�
Mayor or Chairman of Governing B0£%44/'q o mma CIN
`o '0•0
Gary C . Wheeler
Mail completed original application to address shown below.
Florida Department of Revenue
Revenue Accounting Subprocess
PO Box 6609
Tallahassee , FL 32314-6609
850 =617 =8586
REVENUEACCOUNTING@dor. state . fl . us