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					STATE OF WEST VIRGINIA                                                                                              FORM 3
DEPARTMENT OF ADMINISTRATION - FINANCE DIVISION
FINANCIAL ACCOUNTING AND REPORTING SECTION
GAAP REPORTING FORM - MATERIAL AND SUPPLIES INVENTORY


Agency Name:

   PHYSICAL INVENTORY ACCUMULATION FORM

                                        NOTE: THIS FORM HAS A $25,000 MATERIALITY LEVEL
                                              PER LOCATION (e.g. per State Hospital)

                      1                               2                3                   4                             5

                 Description                       Quantity         Unit Cost           Unit of                    Total Cost
                                                                                       Measure               (Column 2 X Column 3)
                                                                                                         $                       -
                                                                                                         $                       -
                                                                                                         $                       -
                                                                                                         $                       -
                                                                                                         $                       -
                                                                                                         $                       -
                                                                                                         $                       -
                                                                                                         $                       -
                                                                                                         $                       -
                                                                                                         $                       -
                                                                                                         $                       -
                                                                                                         $                       -
                                                                                                         $                       -
                                                                                                         $                       -
                                                                                                         $                       -
                                                                                                         $                       -
                                                                                                         $                       -
                                                                                                         $                       -
                                                                                                         $                       -

6. VALUATION METHOD (FIFO, LIFO, Average Cost)                             TOTAL:                        $                       -




                                                                                Please mail backup support to:
Prepared By
                                                                                State of West Virginia
                                                                                Financial Accounting Reporting Section
Agency Telephone Number                                                         Building 17, 3rd Floor
                                                                                2101 Washington Street East
                                                                                Charleston, WV 25305

Date                                                                            Fax Number 304-558-4084
                                                                                FARS contact: Jane Shinn 304-558-4083
                                                                                Jane's email is Jane.A.Shinn@wv.gov




       Tab 3-1
STATE OF WEST VIRGINIA                                                                                                        FORM 3
DEPARTMENT OF ADMINISTRATION - FINANCE DIVISION
FINANCIAL ACCOUNTING AND REPORTING SECTION
GAAP REPORTING FORM - MATERIAL AND SUPPLIES INVENTORY

 PURPOSE
 To accumulate the value of material and supplies inventory (exclusive of Fixed Assets, which are addressed on a separate Closing
 Form,) on hand at June 30, based on a physical inventory count.

 ACCOUNTING POLICY
 Inventories are defined as the amount of goods on hand which may be held for internal consumption or for resale to other units of state
 government or outside parties. Although materials and supplies are recorded by the State as expenditures at the time of purchase, the
 unused balance on hand at year-end must be included in the State's financial reports.

 In order to accumulate this information, a physical count of items on hand must be performed, using the periodic or perpetual inventory
 method. If using the periodic inventory system, the physical inventory should be taken at June 30, or, if using the perpetual system, it may be
 taken on a cyclical basis (i.e. a portion of the materials and supplies may be counted and verified periodically during the year).

 PROCEDURES

 1.       Count: These inventories should ordinarily be maintained in a central storage area where they can be counted quickly. If the
 agency/department estimates its inventory has a value greater than $25,000 per location (e.g. per State Hospital), it should conduct a physical
 inventory on the last working day before June 30. If you regularly perform a physical count on a different time interval, please provide a roll-
 forward of activity from the date of your last physical count to June 30.

 2.     Valuation: Agencies/departments who are not on another valuation method should use the first-in, first-out (FIFO) valuation method to
 report physical inventories (see #6 under instructions). Once the physical count is performed, invoices and other documentation must be used
 to compute the value of the inventory. Physical inventories should be summarized into general classifications using the attached form.

 If you have any questions or problems performing a physical inventory count, please contact FARS (304-558-4083).




 SOURCES OF DATA

               1. Invoice (this invoice needs to be the last invoice received for the particular item prior to June 30)
               2. Physical count

 INSTRUCTIONS


 Use the Physical Inventory Accumulation Form to record your physical count. If your agency maintains a computerized inventory listing
 containing a description of each inventory item, quantity on hand, individual cost for each item, and grand total, then the physical inventory
 accumulation form only needs to be submitted with a grand total and a copy of your inventory listing. This is for your total Inventory at June
 30.

 FARS has placed a $25,000 materiality limit on inventory per location. If you do not have $25,000 worth of inventory at June 30,
 please check N/A on the transmittal form.

 The balance on hand at year end will include those goods which are in transit and are FOB shipping point - meaning title passes to the
 purchaser once goods are placed on the carrier from the point of origin. If you have goods in transit which are FOB shipping point, be sure to
 include these in your count. Include in Column:

       1.      A description of each inventory item on hand at June 30 (DO NOT INCLUDE FIXED ASSETS). As you begin to count each item,
               record it by name and brief description (if not obvious).

       2.      The quantity of inventory items. Enter your inventory count here (please use decimals not fractions).

       3.      This column is for individual cost of each item. Determine the unit cost for each item from the invoice or other relevant source.

       4.      This column is for the unit of measure. A listing of valid codes is included after the instructions for this form.

       5.      The total of Column 2 multiplied by Column 3 will yield the value of the inventory items on hand at June 30. If it is obvious that
               your agency does not have $25,000 worth of inventory, please check N/A on the transmittal form.

       6.      Valuation Method




     Tab 3-1
STATE OF WEST VIRGINIA                                                                                                  FORM 3
DEPARTMENT OF ADMINISTRATION - FINANCE DIVISION
FINANCIAL ACCOUNTING AND REPORTING SECTION
GAAP REPORTING FORM - MATERIAL AND SUPPLIES INVENTORY




 Enter the cost method used to value the inventory in the box located at the bottom of the form. Use first-in, first-out (FIFO) if no method was
 previously adopted.

 Valuation Methods

        FIFO - (first-in, first-out) the goods purchased first are the goods used first; therefore ending inventory consists of items most recently
       purchased.

       LIFO - (last-in, first-out) the goods purchased most recently are the goods used first; therefore, ending inventory consists of items
       purchased first.

       Average Cost - the total dollar amount of inventory is divided by the number of goods for an average cost per item.

       7.      UNITS OF MEASURE
                   UNITS
                    OF
                   MEASURE                      DESCRIPTION
                   AC                           Acre
                   BD                           Bundle
                   BG                           Bag
                   BL                           Barrel
                   BT                           Bottle
                   BU                           Bushel
                   BX                           Box
                   C                            Cycle
                   CCF                          Price per Hundred Cubic Feet
                   CF                           Cubic Feet
                   CI                           Cubic Inch
                   CN                           Can
                   CS                           Case
                   CT                           Carton
                   CU                           Cube
                   CW                           Hundred Weight (per Hundred Weight
                                                (Paper, Steel, etc.))
                   CY                           Cubic Yard (27 cubic feet)
                   DG                            Diluted Gallons
                   DOS                           Dose
                   DR                            Drum
                   DZ                            Dozen
                   EA                            Each
                   FT                            Foot
                   GL                            Gallon (4 Quarts)
                   GM                           Gram
                   IN                            Inch
                   KG                            Kilogram (1000 Grams)
                   KT                            Kit
                   LB                            Pound (16 ounces)
                   LF                            Lineal Foot
                   LNE                           Line
                   LS                            Lump Sum
                   LT                            Liter (.2462 US Gallon)
                   MCF                           MCFT (Price per Thousand Feet (Fuel))
                   ML                            Milliliter (0.0338 US Fluid Ounces)
                   MT                            Metric Ton
                   OZ                            Ounce
                   PC                            Per Hundred
                   PG                            Page
                   PM                            Per Thousand
                   PR                            Pair
                   PT                            Pint (16 Fluid Ounces)
                   QR                            Quire (24 Sheets)
                   QT                            Quart (2 Pints)
                   RD                            Rod (5 ½ Yards)
                   RL                            Roll
                   RM                            Ream (20 Quires)
                   SF                            Square Foot (144 Square Inches)
                   SH                            Sheet
                   SI                           Square Inch (.007 Square Foot)
                   SM                           Square Mile (640 Acres)
                   SR                           Square Rod (30 1/4 Yards)
                   ST                           Set
                   SY                           Square Yard (9 Square Feet)
                   TB                           Tube
                   TN                           Ton
                   U                             Unit
                   VIL                           Vial
                   YD                            Yard




     Tab 3-1
STATE OF WEST VIRGINIA                                                                                                      FORM 3
DEPARTMENT OF ADMINISTRATION - FINANCE DIVISION
FINANCIAL ACCOUNTING AND REPORTING SECTION

GAAP REPORTING FORM - MATERIAL AND SUPPLIES INVENTORY

Agency Name:

   PHYSICAL INVENTORY ACCUMULATION FORM

                                            NOTE: THIS FORM HAS A $25,000 MATERIALITY LEVEL
                                                  PER LOCATION (e.g. per State Hospital)

                      1                               2                  3                    4                               5

                  Description                      Quantity         Unit Cost              Unit of                        Total Cost
                                                                                          Measure                   (Column 2 X Column 3)
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -

6. VALUATION METHOD (FIFO, LIFO, Average Cost)                                TOTAL:                        $                               -

                                                                 Total from 3-1 plus current total          $                               -

                                                                                   Please mail backup support to:
Prepared By
                                                                                   State of West Virginia
                                                                                   Financial Accounting Reporting Section
Agency Telephone Number                                                            Building 17, 3rd Floor
                                                                                   2101 Washington Street East
                                                                                   Charleston, WV 25305

Date                                                                               Fax Number 304-558-4084
                                                                                   FARS contact: Jane Shinn 304-558-4083
                                                                                   Jane's email is Jane.A.Shinn@wv.gov




Tab 3-2
STATE OF WEST VIRGINIA                                                                                                      FORM 3
DEPARTMENT OF ADMINISTRATION - FINANCE DIVISION
FINANCIAL ACCOUNTING AND REPORTING SECTION

GAAP REPORTING FORM - MATERIAL AND SUPPLIES INVENTORY

Agency Name:

   PHYSICAL INVENTORY ACCUMULATION FORM

                                           NOTE: THIS FORM HAS A $25,000 MATERIALITY LEVEL
                                                 PER LOCATION (e.g. per State Hospital)

                      1                               2                  3                    4                               5

                  Description                      Quantity         Unit Cost              Unit of                        Total Cost
                                                                                          Measure                   (Column 2 X Column 3)
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -

6. VALUATION METHOD (FIFO, LIFO, Average Cost)                                TOTAL:                        $                               -

                                                                 Total from 3-2 plus current total          $                               -

                                                                                   Please mail backup support to:
Prepared By
                                                                                   State of West Virginia
                                                                                   Financial Accounting Reporting Section
Agency Telephone Number                                                            Building 17, 3rd Floor
                                                                                   2101 Washington Street East
                                                                                   Charleston, WV 25305

Date                                                                               Fax Number 304-558-4084
                                                                                   FARS contact: Jane Shinn 304-558-4083
                                                                                   Jane's email is Jane.A.Shinn@wv.gov




Tab 3-3
STATE OF WEST VIRGINIA                                                                                                      FORM 3
DEPARTMENT OF ADMINISTRATION - FINANCE DIVISION
FINANCIAL ACCOUNTING AND REPORTING SECTION

GAAP REPORTING FORM - MATERIAL AND SUPPLIES INVENTORY

Agency Name:

   PHYSICAL INVENTORY ACCUMULATION FORM

                                           NOTE: THIS FORM HAS A $25,000 MATERIALITY LEVEL
                                                 PER LOCATION (e.g. per State Hospital)

                      1                               2                  3                    4                               5

                  Description                      Quantity         Unit Cost              Unit of                        Total Cost
                                                                                          Measure                   (Column 2 X Column 3)
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -

6. VALUATION METHOD (FIFO, LIFO, Average Cost)                                TOTAL:                        $                               -

                                                                 Total from 3-3 plus current total          $                               -

                                                                                   Please mail backup support to:
Prepared By
                                                                                   State of West Virginia
                                                                                   Financial Accounting Reporting Section
Agency Telephone Number                                                            Building 17, 3rd Floor
                                                                                   2101 Washington Street East
                                                                                   Charleston, WV 25305

Date                                                                               Fax Number 304-558-4084
                                                                                   FARS contact: Jane Shinn 304-558-4083
                                                                                   Jane's email is Jane.A.Shinn@wv.gov




Tab 3-4
STATE OF WEST VIRGINIA                                                                                                      FORM 3
DEPARTMENT OF ADMINISTRATION - FINANCE DIVISION
FINANCIAL ACCOUNTING AND REPORTING SECTION

GAAP REPORTING FORM - MATERIAL AND SUPPLIES INVENTORY

Agency Name:

   PHYSICAL INVENTORY ACCUMULATION FORM

                                            NOTE: THIS FORM HAS A $25,000 MATERIALITY LEVEL
                                                  PER LOCATION (e.g. per State Hospital)

                      1                                2                 3                    4                               5

                  Description                       Quantity        Unit Cost              Unit of                        Total Cost
                                                                                          Measure                   (Column 2 X Column 3)
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -

6. VALUATION METHOD (FIFO, LIFO, Average Cost)                                TOTAL:                        $                               -

                                                                 Total from 3-4 plus current total          $                               -

                                                                                   Please mail backup support to:
Prepared By
                                                                                   State of West Virginia
                                                                                   Financial Accounting Reporting Section
Agency Telephone Number                                                            Building 17, 3rd Floor
                                                                                   2101 Washington Street East
                                                                                   Charleston, WV 25305

Date                                                                               Fax Number 304-558-4084
                                                                                   FARS contact: Jane Shinn 304-558-4083
                                                                                   Jane's email is Jane.A.Shinn@wv.gov




Tab 3-5
STATE OF WEST VIRGINIA                                                                                                      FORM 3
DEPARTMENT OF ADMINISTRATION - FINANCE DIVISION
FINANCIAL ACCOUNTING AND REPORTING SECTION

GAAP REPORTING FORM - MATERIAL AND SUPPLIES INVENTORY

Agency Name:

   PHYSICAL INVENTORY ACCUMULATION FORM

                                            NOTE: THIS FORM HAS A $25,000 MATERIALITY LEVEL
                                                  PER LOCATION (e.g. per State Hospital)

                      1                               2                  3                    4                               5

                  Description                      Quantity         Unit Cost              Unit of                        Total Cost
                                                                                          Measure                   (Column 2 X Column 3)
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -

6. VALUATION METHOD (FIFO, LIFO, Average Cost)                                TOTAL:                        $                               -

                                                                 Total from 3-5 plus current total          $                               -

                                                                                   Please mail backup support to:
Prepared By
                                                                                   State of West Virginia
                                                                                   Financial Accounting Reporting Section
Agency Telephone Number                                                            Building 17, 3rd Floor
                                                                                   2101 Washington Street East
                                                                                   Charleston, WV 25305

Date                                                                               Fax Number 304-558-4084
                                                                                   FARS contact: Jane Shinn 304-558-4083
                                                                                   Jane's email is Jane.A.Shinn@wv.gov




Tab 3-6
STATE OF WEST VIRGINIA                                                                                                      FORM 3
DEPARTMENT OF ADMINISTRATION - FINANCE DIVISION
FINANCIAL ACCOUNTING AND REPORTING SECTION

GAAP REPORTING FORM - MATERIAL AND SUPPLIES INVENTORY

Agency Name:

   PHYSICAL INVENTORY ACCUMULATION FORM

                                           NOTE: THIS FORM HAS A $25,000 MATERIALITY LEVEL
                                                 PER LOCATION (e.g. per State Hospital)

                      1                               2                  3                    4                               5

                  Description                      Quantity         Unit Cost              Unit of                        Total Cost
                                                                                          Measure                   (Column 2 X Column 3)
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -

6. VALUATION METHOD (FIFO, LIFO, Average Cost)                                TOTAL:                        $                               -

                                                                 Total from 3-6 plus current total          $                               -

                                                                                   Please mail backup support to:
Prepared By
                                                                                   State of West Virginia
                                                                                   Financial Accounting Reporting Section
Agency Telephone Number                                                            Building 17, 3rd Floor
                                                                                   2101 Washington Street East
                                                                                   Charleston, WV 25305

Date                                                                               Fax Number 304-558-4084
                                                                                   FARS contact: Jane Shinn 304-558-4083
                                                                                   Jane's email is Jane.A.Shinn@wv.gov




Tab 3-7
STATE OF WEST VIRGINIA                                                                                                      FORM 3
DEPARTMENT OF ADMINISTRATION - FINANCE DIVISION
FINANCIAL ACCOUNTING AND REPORTING SECTION

GAAP REPORTING FORM - MATERIAL AND SUPPLIES INVENTORY

Agency Name:

   PHYSICAL INVENTORY ACCUMULATION FORM

                                           NOTE: THIS FORM HAS A $25,000 MATERIALITY LEVEL
                                                 PER LOCATION (e.g. per State Hospital)

                      1                               2                  3                    4                               5

                  Description                      Quantity         Unit Cost              Unit of                        Total Cost
                                                                                          Measure                   (Column 2 X Column 3)
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -
                                                                                                            $                               -

6. VALUATION METHOD (FIFO, LIFO, Average Cost)                                TOTAL:                        $                               -

                                                                 Total from 3-7 plus current total          $                               -

                                                                                   Please mail backup support to:
Prepared By
                                                                                   State of West Virginia
                                                                                   Financial Accounting Reporting Section
Agency Telephone Number                                                            Building 17, 3rd Floor
                                                                                   2101 Washington Street East
                                                                                   Charleston, WV 25305

Date                                                                               Fax Number 304-558-4084
                                                                                   FARS contact: Jane Shinn 304-558-4083
                                                                                   Jane's email is Jane.A.Shinn@wv.gov




Tab 3-8
STATE OF WEST VIRGINIA                                                                                                     FORM 3
DEPARTMENT OF ADMINISTRATION - FINANCE DIVISION
FINANCIAL ACCOUNTING AND REPORTING SECTION

GAAP REPORTING FORM - MATERIAL AND SUPPLIES INVENTORY

Agency Name:

   PHYSICAL INVENTORY ACCUMULATION FORM

                                           NOTE: THIS FORM HAS A $25,000 MATERIALITY LEVEL
                                                 PER LOCATION (e.g. per State Hospital)

                      1                               2                 3                    4                               5

                  Description                      Quantity         Unit Cost             Unit of                        Total Cost
                                                                                         Measure                   (Column 2 X Column 3)
                                                                                                           $                               -
                                                                                                           $                               -
                                                                                                           $                               -
                                                                                                           $                               -
                                                                                                           $                               -
                                                                                                           $                               -
                                                                                                           $                               -
                                                                                                           $                               -
                                                                                                           $                               -
                                                                                                           $                               -
                                                                                                           $                               -
                                                                                                           $                               -
                                                                                                           $                               -
                                                                                                           $                               -
                                                                                                           $                               -
                                                                                                           $                               -
                                                                                                           $                               -
                                                                                                           $                               -
                                                                                                           $                               -

6. VALUATION METHOD (FIFO, LIFO, Average Cost)                               TOTAL:                        $                               -

                                                                Total from 3-8 plus current total          $                               -

                                                                                  Please mail backup support to:
Prepared By
                                                                                  State of West Virginia
                                                                                  Financial Accounting Reporting Section
Agency Telephone Number                                                           Building 17, 3rd Floor
                                                                                  2101 Washington Street East
                                                                                  Charleston, WV 25305

Date                                                                              Fax Number 304-558-4084
                                                                                  FARS contact: Jane Shinn 304-558-4083
                                                                                  Jane's email is Jane.A.Shinn@wv.gov




Tab 3-9
STATE OF WEST VIRGINIA                                                                                                    FORM 3
DEPARTMENT OF ADMINISTRATION - FINANCE DIVISION
FINANCIAL ACCOUNTING AND REPORTING SECTION

GAAP REPORTING FORM - MATERIAL AND SUPPLIES INVENTORY
                                                                                      This form has ten pages numbered 3-1 thru 3-10.
Agency Name:                                                                          A few agencies will require more pages. To download
                                                                                      an expanded multi-page file, click the following link:
   PHYSICAL INVENTORY ACCUMULATION FORM                                               http://www.wvfinance.state.wv.us/forms/FARSforms/form3.xls
                                                                                      (this will take several minutes)
                                        NOTE: THIS FORM HAS A $25,000 MATERIALITY LEVEL
                                              PER LOCATION (e.g. per State Hospital)

                      1                                2                 3                     4                              5

                 Description                        Quantity         Unit Cost             Unit of                      Total Cost
                                                                                          Measure                 (Column 2 X Column 3)
                                                                                                              $                            -
                                                                                                              $                            -
                                                                                                              $                            -
                                                                                                              $                            -
                                                                                                              $                            -
                                                                                                              $                            -
                                                                                                              $                            -
                                                                                                              $                            -
                                                                                                              $                            -
                                                                                                              $                            -
                                                                                                              $                            -
                                                                                                              $                            -
                                                                                                              $                            -
                                                                                                              $                            -
                                                                                                              $                            -
                                                                                                              $                            -
                                                                                                              $                            -
                                                                                                              $                            -
                                                                                                              $                            -

6. VALUATION METHOD (FIFO, LIFO, Average Cost)                               TOTAL:                           $                            -

                                                                 Total from 3-9 plus current total            $                            -

                                                                                   Please mail backup support to:
Prepared By
                                                                                   State of West Virginia
                                                                                   Financial Accounting Reporting Section
Agency Telephone Number                                                            Building 17, 3rd Floor
                                                                                   2101 Washington Street East
                                                                                   Charleston, WV 25305

Date                                                                               Fax Number 304-558-4084
                                                                                   FARS contact: Jane Shinn 304-558-4083
                                                                                   Jane's email is Jane.A.Shinn@wv.gov




3-10

				
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