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Extension Form for Irrevocable Trust

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Extension Form for Irrevocable Trust Powered By Docstoc
					                      Department of State Treasurer
          *******     ITEMS FOR THIS REPORT                 ******
   The LGC 203 Form has been revised for 6/30/2008.
   Please review the form carefully.
   The long detail instructions now reside in a separate file.
   Only enter your data in the yellow boxes, the blue boxes contain formulas.
   Lines have been added to LGC203 - PG 1, Section IV (Investments) for:
     1) OPEB Trust Fund - State Treasurer
     2) OPEB Trust Fund - Other (Provide portfolio listing separately)
               Note: OPEB investments in irrevocable trusts should only be presented on these 2 lines.
     3) Hospital Funds Invested with State Treasurer
   Do not use an old LGC 203 form if these new lines apply to your unit !
   Contact Michael Phillips with any questions:
     919-807-2384
     Michael.Phillips@nctreasurer.com
   Send completed forms to the following LGC 203 email box:
          LGC0203@nctreasurer.com
   Or fax to: 919-807-2398
   Or mail to: N.C. Department of State Treasurer
                 Local Government Commission
                 325 N. Salisbury Street
                 Raleigh, NC 27603-1385
    Please remember to email, fax, or mail all confirmations & other relevant supporting information.

   Please submit the LGC 203 report by the due date of July 25, 2008.
LGC 203 (Rev. 06-08)
                                                                                                                                                                                                    IMPORTANT-Please read the
                                                                                                                                                                                                   enclosed instructions and refer to
                                                                                                                                                                                                 sample 203 for additional assistance.
                                                                                          State of North Carolina
                                                                                 LOCAL GOVERNMENT COMMISSION
                                                                       325 North Salisbury Street, Raleigh, North Carolina 27603-1385
                                                                              REPORT OF DEPOSITS AND INVESTMENTS                                                                                     Day/Month                  Year
                                                                              (As required by G.S. 159-33 and G.S. 115C-446)

Full Name of Unit:                                                                                                                                                                      As of:
                                       Include names of component units or other units reported with the primary government.                                                                         (June 30 or December 31, and Year)
Does the unit have a written cash management policy?       (Yes or No)                             Has this policy been approved by the Board?                                                                            (Yes or No)
Are custodial arrangements in compliance with G.S. 159-30(c)(12) and G.S. 159-30(d) or G.S. 115C-443(d)?                                                                                         (Yes or No)
Does the unit have a cash concentration account and/or a central depository system in place?                                 (Yes or No)

I.       Cash on hand (see Instruction 2).                                                                                                Amount
         Petty cash funds and change funds                        ……………………………………………
         Undeposited receipts                                     ……………………………………………                                                                                                                     Total Cash on Hand
               Total cash on hand                                 ……………………………………………                                                                                 Manual Preparers:
                                                                                                                                                                                                 $                                        -
                                                                                                                                                                    ENTER THIS NUMBER ON PAGE 2 SECTION VII LINE 1
II. Dedicated Method Financial Institution (see Instruction 3 & 5):                                     Note: All Housing Authorities must use the Dedicated Method rules.
                                                                             A                                         B                                                      C
         (fill out Section VIII                                            Demand                                    Time                                             Interest Bearing
                for each Dedicated Bank)                                   Deposits                                 Deposits                                         Checking Accounts
                                                                    (Non-interest bearing)           Regular Savings                       C.D.s
           (1)

           (2)

                 Supplemental Pages (Dedicated Method)                                     -                            -                               -                                 -           Grand Total - Dedicated

                    Totals for All Dedicated Banks                 $                       -     $                      -       $                       -           $                     -      $                                        -
                                                                                                                                                                    Manual Preparers:            ENTER THIS NUMBER ON
                                                                                                                                                                                                 PAGE 2 SECTION VII LINE 2

III. Pooling Method Financial Institutions (see Instruction 3 & 6):                                                             LIST ONLY BANKS INCLUDED ON POOLING BANK MEMO

           (1)

           (2)

           (3)

           (4)

                 Supplemental Pages (Pooling Method)                                       -                            -                               -                                 -            Grand Total - Pooling

                    Totals for All Pooling Banks                   $                       -     $                      -       $                       -           $                     -      $                                   -
                                                                                                                                                                    Manual Preparers:            ENTER THIS NUMBER ON
                                                                                                                                                                                                 PAGE 2 SECTION VII LINE 3
IV. Investments (see Instruction 7): Supplemental schedules may be attached with details but totals of market value are required for each type .*
                                                                                                                                          Amount
         North Carolina Capital Management Trust Cash Portfolio
         North Carolina Capital Management Trust Term Portfolio
         Short Term Investment Fund (STIF)
         OPEB Trust Fund - State Treasurer
         OPEB Trust Fund - Other (Please provide a copy of portfolio listing).
         Hospital Funds Invested with State Treasurer
                                         Name of Custodian
         Government Securities             or Safekeeper                Type of Security             Purchase Amount                   Market Value                      Purchase Date             Maturity Date              Yielda



                                       Total from LGC-203 Front- Supplementals                                                                        -
                                                                                                 Total by Type*
                                                                                                                                   $                  -
                                         Name of Custodian
         Government Agencies               or Safekeeper                Type of Security             Purchase Amount                   Market Value                      Purchase Date             Maturity Date              Yielda



                                       Total from LGC-203 Front- Supplementals                                                                        -
                                                                                                 Total by Type*                    $                  -
                                         Name of Custodian
         Commercial Paper                  or Safekeeper                     Issuer                  Purchase Amount                   Maturity Value                    Purchase Date             Maturity Date              Yielda



                                       Total from LGC-203 Front- Supplementals                                                                        -
                                                                                                                                   $                  -
                                         Name of Custodian
         Bankers' Acceptance               or Safekeeper                     Bank                    Purchase Amount                   Maturity Value                    Purchase Date             Maturity Date              Yielda


                                       Total from LGC-203 Front- Supplementals                                                                        -
                                                                                                 Total by Type*                    $                        -
                                         Name of Custodian
         Other Investments                 or Safekeeper          Type of Investment                 Purchase Amount                   Market Value                      Purchase Date             Maturity Date              Yielda


                                       Total from LGC-203 Front- Supplementals                                                                        -
a
    All yields should be quoted on a bond-equivalent basis.                                      Total by Type*                    $                        -
V.       Repurchase Agreements (see Instruction 8):                                                                                                                        Name of                    Is Master
                        Purchase                                            Type of                                                                                        Custodian                 Repo Agree-
     Institution          Date              Maturity Date              Security Purchased            Purchase Amount                   Market Value                      or Safekeeper               ment Used?                Yield


                                       Total from LGC-203 Front- Supplementals                                                                        -
                                                                                                 Total by Type*                 $                           -
                                                                  Grand Total of Sect. IV & V Investments:
                                                                  (See Instruction 9)                                          $                                -
                                                                                                Manual Preparers:              ENTER THIS NUMBER ON
                                                                                                                               PAGE 2 SECTION VII LINE 5
LGC 203 (Rev. 06-08), Page 2

                                                                      REPORT OF DEPOSITS AND INVESTMENTS

VI.    Analysis of Interest Bearing Checking

                           Financial Institution                                          Amount                                                            Yield




                                                                  TOTAL               $              -

VII. Summary (see Instruction 11): Please recheck totals.
                                             (1) Cash on hand (ENTER TOTAL FROM PAGE 1 SECTION I)                                       $                              -
                                             (2) Total cash on deposit for Dedicated Method (SECTION II)                                                               -
                                             (3) Total cash on deposit for Pooling Method (SECTION III)                                                                -
                                             (4)        Total cash                                                                                                                               -
                                                     (5) Investments (totals Section IV & V)                                                                                                     -
                                                     (6)        Total cash and investments (lines 4 plus 5)                                                                                      -


                                                     (7) Less: Unexpended bond and/or note proceeds
                                                     (8)       Net cash and investments (line 6 minus 7)                                                                                         -


VIII. Deposits in Dedicated Method Financial Institutions: (See Instruction 12)                                                 REQUIRED FOR BANKS LISTED ON PAGE 1 IN SECTION II

       Name of financial institution (1)                                                                 0                                                Securities Pledged as Collateral
                                                                            (a)                (b)             (a)-(b)                                    with Third Party Escrow Agent
                                                                       Deposit        FDIC Insured           Uninsured                                                      Market Value at June 30 or
                                                                       Amount           Amount                Amount                                                              December 31

       Non-interest bearing deposits (Col. A, Sec. II)            $               -   $        100,000              -                            U.S. Treas. & agencies




       Time deposits (Col. B, Sec. II)                            $               -                                                              State of N.C.
                                                                                                                                                 /county/municipal
       NOW, SUPERNOW, and Money Market
         deposit accounts (Col. C, Sec. II)                       $               -                                                              Other


          Total Interest Bearing Accounts:                        $               -   $        100,000              -                            Total Pledged:*             $                   -

Name of Escrow Agent (or Federal Reserve Bank location, if applicable).                                                                            * Attach confirmation from depository.
Is there a signed escrow agreement in place (nonapplicable for Federal Reserve Bank)?                                           No___   Yes___
Does the unit receive timely confirmations of pledged collateral from the escrow agent?                                         No___   Yes___



       Name of financial institution (2)                                                                 0                                                Securities Pledged as Collateral
                                                                            (a)                (b)             (a)-(b)                                    with Third Party Escrow Agent
                                                                       Deposit        FDIC Insured           Uninsured                                                      Market Value at June 30 or
                                                                       Amount           Amount                Amount                                                              December 31

       Non-interest bearing deposits (Col. A, Sec. II)            $               -   $        100,000              -
                                                                                                                                                 U.S. Treas. & agencies

       Time deposits (Col. B, Sec. II)                            $               -                                                              State of N.C.
                                                                                                                                                 /county/municipal
       NOW, SUPERNOW, and Money Market
         deposit accounts (Col. C, Sec. II)                                       -                                                              Other (attach list)


          Total Interest Bearing Accounts:                        $               -   $        100,000              -                            Total Pledged:*                                     -

Name of Escrow Agent (or Federal Reserve Bank location, if applicable).                                                                            * Attach confirmation from depository.
Is there a signed escrow agreement in place (nonapplicable for Federal Reserve Bank)?                                           No___   Yes___
Does the unit receive timely confirmations of pledged collateral from the escrow agent?                                         No___   Yes___


                                                    Signature of Official                                                Date                      Telephone Number (include area code)
CERTIFICATION                                                                                                                                              Number                  Extension
This is to certify that the                         Name of Official
data contained in this                                                                                                                                   Fax Number (include area code)
report are accurate to the                          Title                                                                                                  Number
best of my knowledge
and belief.                                         Address
                                                                                                                                        E-mail Address:
LGC 203 (Rev. 12-02)
                                                                                                                                                                   IMPORTANT-Please read the enclosed
                                                                                                                                                                   instructions and refer to sample 203 for
                                                                                                                                                                             additional assistance.




                                                                     SUPPLEMENTAL SCHEDULE
                                                                                   State of North Carolina
                                                                          LOCAL GOVERNMENT COMMISSION
                                                                325 North Salisbury Street, Raleigh, North Carolina 27603-1385
                                                                      REPORT OF DEPOSITS AND INVESTMENTS
                                                                       (As required by G.S. 159-33 and G.S. 115C-446)
                                                                                                                                                                        Day/Month                  Year
Full Name of Unit:                                                                                                                     0                  As of:         0-Jan                       0
                                                                                                                                                                        (June 30 or December 31, and Year)


II. Dedicated Method Financial Institution (see Instruction 6):               Note: All Housing Authorities must use the Dedicated Method rules.

        (fill out Section VIII for each Dedicated Bank)              A                                     B                                         C
                                                                  Demand                                 Time                                Interest Bearing
                                                                  Deposits                              Deposits                            Checking Accounts
                                                           (Non-interest bearing)        Regular Savings               C.D.s

          (3)

          (4)

          (5)

                Subtotal - Bring forward to main form     $                   -      $                  -      $                   -       $                   -

III. Pooling Method Financial Institutions (see Instruction 7):                                               LIST ONLY BANKS INCLUDED ON POOLING BANK MEMO

          (5)

          (6)

          (7)

          (8)

                Subtotal - Bring forward to main form.    $                   -      $                  -      $                   -       $                   -

IV. Investments (see Instruction 8): Include the market values listed below in Totals by Type on the main form.
                                      Name of Custodian
                                        or Safekeeper         Type of Security           Purchase Amount           Market Value                Purchase Date        Maturity Date                Yield*
        Government Securities




                                                          Subtotal                                                                         Manual Preparers- Carry forward to LGC203 Front
                                                                                                               $                   -
                                      Name of Custodian
                                        or Safekeeper         Type of Security           Purchase Amount           Market Value                Purchase Date        Maturity Date                Yield*
        Government Agencies




                                                          Subtotal
                                                                                                               $                   -       Manual Preparers- Carry forward to LGC203 Front
                                      Name of Custodian
                                        or Safekeeper                Issuer              Purchase Amount           Maturity Value              Purchase Date        Maturity Date                Yield*
        Commercial Paper




                                                          Subtotal                                                                         Manual Preparers- Carry forward to LGC203 Front
                                                                                                               $                   -
                                      Name of Custodian
                                        or Safekeeper                Bank                Purchase Amount           Maturity Value              Purchase Date        Maturity Date                Yield*
        Bankers' Acceptance


                                                          Subtotal                                                                         Manual Preparers- Carry forward to LGC203 Front
                                                                                                               $                   -
                                      Name of Custodian
                                        or Safekeeper     Type of Investment             Purchase Amount           Market Value                Purchase Date        Maturity Date                Yield*
        Other Investments


                                                          Subtotal                                                                         Manual Preparers- Carry forward to LGC203 Front
                                                                                                               $                   -

* All yields should be quoted on a bond-equivalent basis.
V.      Repurchase Agreements (see Instruction 9):                                                                                               Name of               Is Master
                        Purchase                                   Type of                                                                       Custodian            Repo Agree-
     Institution          Date            Maturity Date       Security Purchased         Purchase Amount            Market Value               or Safekeeper          ment Used?                  Yield



                                                          Subtotal                                             $                       -   Manual Preparers- Carry forward to LGC203 Front
LGC 203 (Rev. 12-02)
                                                                                                                                                                      IMPORTANT-Please read the enclosed
                                                                                                                                                                      instructions and refer to sample 203 for
                                                                                                                                                                                additional assistance.




                                                                     SUPPLEMENTAL SCHEDULE
                                                                                    State of North Carolina
                                                                           LOCAL GOVERNMENT COMMISSION
                                                                 325 North Salisbury Street, Raleigh, North Carolina 27603-1385
                                                                       REPORT OF DEPOSITS AND INVESTMENTS
                                                                        (As required by G.S. 159-33 and G.S. 115C-446)
                                                                                                                                                                           Day/Month                 Year
Full Name of Unit:                                                                                                                        0                  As of:         0-Jan                      0
                                                                                                                                                                          (June 30 or December 31, and Year)


II. Dedicated Method Financial Institution (see Instruction 6):                     Note: All Housing Authorities must use the Dedicated Method rules.
        (fill out Section VIII for each Dedicated Bank)             A                                        B                                          C
                                                                  Demand                                    Time                                Interest Bearing
                                                                  Deposits                                 Deposits                            Checking Accounts
                                                           (Non-interest bearing)        Regular Savings                  C.D.s

          (6)

          (7)

          (8)

                Subtotal - Bring forward to main form     $                   -      $                 -        $                     -       $                   -

III. Pooling Method Financial Institutions (see Instruction 7):                                                LIST ONLY BANKS INCLUDED ON POOLING BANK MEMO

          (9)

         (10)

         (11)

         (12)

                Subtotal - Bring forward to main form.    $                   -      $                 -        $                     -       $                   -

IV. Investments (see Instruction 8): Include the market values listed below in Totals by Type on the main form.
                                      Name of Custodian
                                        or Safekeeper         Type of Security           Purchase Amount              Market Value                Purchase Date        Maturity Date               Yield*
        Government Securities




                                                          Subtotal                                                                            Manual Preparers- Carry forward to LGC203 Front
                                                                                                                $                     -
                                      Name of Custodian
                                        or Safekeeper         Type of Security           Purchase Amount              Market Value                Purchase Date        Maturity Date               Yield*
        Government Agencies




                                                          Subtotal                                                                            Manual Preparers- Carry forward to LGC203 Front
                                                                                                                $                     -
                                      Name of Custodian
                                        or Safekeeper                Issuer              Purchase Amount              Maturity Value              Purchase Date        Maturity Date               Yield*
        Commercial Paper




                                                          Subtotal                                                                            Manual Preparers- Carry forward to LGC203 Front
                                                                                                                $                     -
                                      Name of Custodian
                                        or Safekeeper                Bank                Purchase Amount              Maturity Value              Purchase Date        Maturity Date               Yield*
        Bankers' Acceptance


                                                          Subtotal                                                                            Manual Preparers- Carry forward to LGC203 Front
                                                                                                                $                     -
                                      Name of Custodian
                                        or Safekeeper     Type of Investment             Purchase Amount              Market Value                Purchase Date        Maturity Date               Yield*
        Other Investments


                                                          Subtotal                                                                            Manual Preparers- Carry forward to LGC203 Front
                                                                                                                $                     -

* All yields should be quoted on a bond-equivalent basis.
V.      Repurchase Agreements (see Instruction 9):                                                                                                  Name of               Is Master
                        Purchase                                   Type of                                                                          Custodian            Repo Agree-
     Institution          Date           Maturity Date        Security Purchased         Purchase Amount               Market Value               or Safekeeper          ment Used?                 Yield



                                                          Subtotal                                              $                         -   Manual Preparers- Carry forward to LGC203 Front
LGC 203 (Rev. 7-02), Page 2                                                                                                                               0
                                                                REPORT OF DEPOSITS AND INVESTMENTS

VI.    Analysis of Interest Bearing Checking

                              Financial Institution                               Amount                                                   Yield




                                                            TOTAL             $           -



VIII. Deposits in Dedicated Method Financial Institutions:                    Required for banks listed in Section II


       Name of financial institution (3)                                                      0                                          Securities Pledged as Collateral
                                                                   (a)              (b)             (a)-(b)                              with Third Party Escrow Agent
                                                                Deposit       FDIC Insured        Uninsured                                                   Market Value at June 30 or
                                                                Amount          Amount             Amount                                                           December 31

       Non-interest bearing deposits (Col. A, Sec. II)      $             -   $     100,000              -                       U.S. Treas. & agencies




       Time deposits (Col. B, Sec. II)                      $             -                                                      State of N.C.
                                                                                                                                 /county/municipal
       NOW, SUPERNOW, and Money Market
         deposit accounts (Col. C, Sec. II)                               -                                                      Other


          Total Interest Bearing Accounts:                  $             -   $     100,000              -                       Total Pledged:*              $                    -

Name of Escrow Agent (or Federal Reserve Bank location, if applicable).                                                            * Attach confirmation from depository.
Is there a signed escrow agreement in place (nonapplicable for Federal Reserve Bank)?                           No___   Yes___
Does the unit receive timely confirmations of pledged collateral from the escrow agent?                         No___   Yes___



       Name of financial institution (4)                                                      0                                          Securities Pledged as Collateral
                                                                   (a)              (b)             (a)-(b)                              with Third Party Escrow Agent
                                                                Deposit       FDIC Insured        Uninsured                                                   Market Value at June 30 or
                                                                Amount          Amount             Amount                                                           December 31

       Non-interest bearing deposits (Col. A, Sec. II)      $             -   $     100,000              -
                                                                                                                                 U.S. Treas. & agencies

       Time deposits (Col. B, Sec. II)                      $             -                                                      State of N.C.
                                                                                                                                 /county/municipal
       NOW, SUPERNOW, and Money Market
         deposits accounts (Col. C, Sec. II)                              -                                                      Other


          Total Interest Bearing Accounts:                  $             -   $     100,000              -                       Total Pledged:*              $                    -

Name of Escrow Agent (or Federal Reserve Bank location, if applicable).                                                            * Attach confirmation from depository.
Is there a signed escrow agreement in place (nonapplicable for Federal Reserve Bank)?                           No___   Yes___
Does the unit receive timely confirmations of pledged collateral from the escrow agent?                         No___   Yes___



       Name of financial institution (5)                                                      0                                          Securities Pledged as Collateral
                                                                   (a)              (b)             (a)-(b)                              with Third Party Escrow Agent
                                                                Deposit           Insured         Uninsured                                                   Market Value at June 30 or
                                                                Amount            Amount           Amount                                                           December 31

       Non-interest bearing deposits (Col. A, Sec. II)      $             -   $     100,000              -                       U.S. Treas. & agencies




       Time deposits (Col. B, Sec. II)                      $             -                                                      State of N.C.
                                                                                                                                 /county/municipal
       NOW, SUPERNOW, and Money Market
         deposit accounts (Col. C, Sec. II)                               -                                                      Other


          Total Interest Bearing Accounts:                  $             -   $     100,000              -                       Total Pledged:*              $                    -

Name of Escrow Agent (or Federal Reserve Bank location, if applicable).                                                            * Attach confirmation from depository.
Is there a signed escrow agreement in place (nonapplicable for Federal Reserve Bank)?                           No___   Yes___
Does the unit receive timely confirmations of pledged collateral from the escrow agent?                         No___   Yes___
LGC 203-S (Rev. 7-02)

                                                                State of North Carolina
                                                      LOCAL GOVERNMENT COMMISSION
                                            325 North Salisbury Street, Raleigh, North Carolina 27603-1385
                                                   REPORT OF DEPOSITS AND INVESTMENTS
                                                            (As required by G.S. 115C-446)

                                                                                                                                             Day/Month                   Year
School System                                                                                                                  As of:
                                                                                                                                              (June 30 or December 31, and Year)
INSTRUCTIONS

         1. This report is only for the "special funds of the individual schools." The cash and investments of the administrative unit should be
            reported on the form LGC 203.
         2. Prepare Part II by listing the individual schools since the amount of required collateral must be calculated by individual school. If
            additional space is needed, copy and use as many Part II's as needed or use the supplemental sheets provided.
         3. These funds are not considered "Public Funds" but are trust funds held by the custodian for each individual school. Therefore, the amount
            of deposit insurance available amounts to a total of $100,000 in both demand and time deposits (column 2, 3, and 4 below) for each
            individual school for each financial institution.
         4. Demand deposits are checking accounts which are non-interest bearing.
         5. SUPER NOW and NOW accounts are not considered investments; rather, these are interest earning official depository accounts.
            Certificates of deposit also are deposits and not investments.
         6. List on a separate sheet all investments in column [5]. Show issuer, type of security, purchase date, maturity date, cost value, and market
            value. Attach to LGC 203-S. These investments and the certificates of deposit reported in column [4] should be made on behalf of the
            individual school only by the finance officer of the administrative unit.
         7. Show applicable collateral security information on form LGC 203 in Section VIII. Collateral security covering the school administrative
            unit also covers the individual schools, if applicable, to the extent excess collateralization exists with the same Pool Method financial
            institution.
         8. Prepare and submit an explanation for any school that is under-collateralized.
         9. Foot and cross-foot the cash amounts on each page of Part II and carry forward to the applicable line in Part I - Summary.
      10. Foot and cross-foot Part I - Summary.
      11. Sign certification. Be sure to provide all information requested (name, numbers, address, & email if applicable).
      12. Attach all supplemental date required and submit with LGC 203 for the school administrative unit's own funds.

Part I
         A.      1.   Total number of individual schools.
                 2.   Number of individual schools with special funds.


                                                        [1]                [2]                       [3]                 [4]                    [5]                      [6]
                                                                                                    NOW
                                                                                                 SUPERNOW       Certificates of                Other
                                                  Cash on hand       Demand Deposits              Accounts         Deposit                  Investments                Total
Totals brought forward from
Part II - Page 1 total                        $                  -   $            -          $          -      $                  -     $                -      $                  -
          Page 2 total                                           -                -                     -                         -                      -                         -
          Page 3 total                                                                                                                                                             -
          Page 4 total                                                                                                                                                             -
          Page 5 total                                                                                                                                                             -
          Page 6 total                                                                                                                                                             -
          Page 7 total                                                                                                                                                             -
          Page 8 total                                                                                                                                                             -
          Page 9 total                                                                                                                                                             -
Total All Individual Schools                  $                  -   $            -          $          -      $                  -     $                -      $                  -

* Title of individual responsible for Certificates of Deposit and other Investments.


                                             Signature of Official                    Date                         Telephone Number
CERTIFICATION                                                                                                         Area Code                Number                 Extension
This is to certify that the                  Name of Official
data contained in this                                                                                               Fax Number
report are accurate to the                   Title                                                                    Area Code                Number
best of my knowledge
and belief.                                  Address
                                                                                                                    Email Address


         0
LGC 203-S (Rev. 7-02)


                                             SUPPLEMENTAL SCHEDULE
                                                              State of North Carolina
                                                    LOCAL GOVERNMENT COMMISSION
                                          325 North Salisbury Street, Raleigh, North Carolina 27603-1385
                                                 REPORT OF DEPOSITS AND INVESTMENTS
                                                          (As required by G.S. 115C-446)

                                                                                                                                              Day/Month                   Year
School System                                                                                             0                   As of:            0-Jan                      0
                                                                                                                                               (June 30 or December 31, and Year)


Part I
         A.      1.   Total number of individual schools.                                         0
                 2.   Number of individual schools with special funds.                                                   0


                                                      [1]                [2]                      [3]                   [4]                      [5]                      [6]
                                                                                                 NOW
                                                                                              SUPERNOW        Certificates of                   Other
                                                Cash on hand       Demand Deposits             Accounts          Deposit                     Investments                Total
Totals brought forward from
Part II - Page 10 total                                                                                                                                          $                  -
          Page 11 total                                                                                                                                                             -
          Page 12 total                                                                                                                                                             -
          Page 13 total                                                                                                                                                             -
          Page 14 total                                                                                                                                                             -
          Page 15 total                                                                                                                                                             -
          Page 16 total                                                                                                                                                             -
          Page 17 total                                                                                                                                                             -
          Page 18 total                                                                                                                                                             -
          Page 19 total                                                                                                                                                             -
          Page 20 total                                                                                                                                                             -
Total All Individual Schools                $                  -   $           -          $           -       $                  -       $                -      $                  -

* Title of individual responsible for Certificates of Deposit and other Investments.                                                 0


                                           Signature of Official                   Date                           Telephone Number
CERTIFICATION                                                                                                        Area Code                  Number                 Extension
This is to certify that the                Name of Official                                                                                       0
data contained in this                                                               0                              Fax Number
report are accurate to the                 Title                                                                     Area Code                  Number
best of my knowledge                                                                 0                                                            0
and belief.                                Address
                                                                                                          0        Email Address                                                        0
LGC 203-S (Rev. 07-02), page 2                                                                                                   0
Part II
                                      [1]             [2]              [3]             [4]             [5]            [6]                 [7]
                                                                                                                                      Uninsured
                                                                       NOW
                                                    Demand                       Certificates of      Other                          Amount [2] +
                                 Cash on hand                       SUPERNOW                                         Total
                                                    Deposits                        Deposit        Investments                        [3] + [4] -
                                                                     Accounts
                                                                                                                                      $100,000
Individual School Units
Name of Financial Institution
                                                                                                                 $           -       $       -

                                                                                                                             -               -

                                                                                                                             -               -

                                                                                                                             -               -

                                                                                                                             -               -

                                                                                                                             -               -

                                                                                                                             -               -

                                                                                                                             -               -

                                                                                                                             -               -

                                                                                                                             -               -

                                                                                                                             -               -

                                                                                                                             -               -

                                                                                                                             -               -

                                                                                                                             -               -

                                                                                                                             -               -

                                                                                                                             -               -

                                                                                                                             -               -

                                                                                                                             -               -

                                                                                                                             -               -

                                                                                                                             -               -

                                                                                                                             -               -

                                                                                                                             -               -

                                                                                                                             -               -

                                                                                                                             -               -

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LGC 203-S (Rev. 7-02), page 2                                                                                                       0
Part II
                                       SUPPLEMENTAL SCHEDULE
                                       [1]              [2]               [3]            [4]              [5]            [6]                 [7]
                                                                                                                                         Uninsured
                                                                     NOW
                                                      Demand                        Certificates of      Other                          Amount [2] +
                                  Cash on hand                    SUPERNOW                                              Total
                                                      Deposits                         Deposit        Investments                        [3] + [4] -
                                                                   Accounts
                                                                                                                                         $100,000
Individual School Units
Name of Financial Institution
                                                                                                                    $           -       $       -

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Manual Preparers: Please remember to carry each column total to page 1.
LGC 203 (Rev. 06-08)
                                                                                                                                                                                       IMPORTANT-Please read the enclosed
                                                                                                                                                                                       instructions and refer to sample 203 for
                                       ** Sample **                                                                                                                                              additional assistance.

                                                                                          State of North Carolina
                                                                                 LOCAL GOVERNMENT COMMISSION
                                                                       325 North Salisbury Street, Raleigh, North Carolina 27603-1385
                                                                              REPORT OF DEPOSITS AND INVESTMENTS
                                                                             (As required by G.S. 159-33 and G.S. 115C-446)                                                            Day/Month                 Year

Full Name of Unit:                    XYZ LOCAL GOVERNMENT                                                                                                                  As of:            30-Jun                  2008
                                      Include names of component units or other units reported with the primary government.                                                                 (June 30 or December 31, and Year)
Does the unit have a written cash management policy?       (Yes or No)          YES                Has this policy been approved by the Board?                                         YES                       (Yes or No)
Are custodial arrangements in compliance with G.S. 159-30(c)(12) and G.S. 159-30(d) or G.S. 115C-443(d)?                     YES                                                       (Yes or No)
Does the unit have a cash concentration account and/or a central depository system in place?        YES                      (Yes or No)

I.       Cash on hand (see Instruction 2).                                                                                               Amount
         Petty cash funds and change funds                       ……………………………………………                                                $                100
         Undeposited receipts                                    ……………………………………………                                                                 150                                         Total Cash on Hand
               Total cash on hand                                ……………………………………………
                                                                                                                                                                                        $                                  250
II. Dedicated Method Financial Institution (see Instruction 3 & 5):                                   Note: All Housing Authorities must use the Dedicated Method rules.
                                                                            A                                         B                                             C
         (fill out Section VIII                                           Demand                                    Time                                    Interest Bearing
                for each Dedicated Bank)                                  Deposits                                 Deposits                                Checking Accounts
                                                                   (Non-interest bearing)           Regular Savings                       C.D.s

           (1) Goodfaith Bank                                     $                  1,000                                        $           300,000     $              125,000
                 Dogwood, NC
           (2)

                 Supplemental Pages (Dedicated Method)                                                                                                                                       Grand Total - Dedicated

                   Totals for All Dedicated Banks                 $                  1,000      $                    -            $           300,000     $              125,000        $                            426,000

III. Pooling Method Financial Institutions (see Instruction 3 & 6): Banks should be listed in Pooling Bank Memo.

           (1) Trustworthy Bank                                                                                                               150,000
               Dogwood, NC
           (2) Prime NC Bank                                                                                                                  100,000
               Dogwood, NC
           (3)

           (4)

                 Supplemental Pages (Pooling Method)                                                                                                                                          Grand Total - Pooling

                   Totals for All Pooling Banks                   $                        -    $                        -        $           250,000     $                        -    $                            250,000

IV. Investments (see Instruction 7): Supplemental schedules may be attached with details but totals of market value are required for each type .*
                                                                                                                                         Amount
         North Carolina Capital Management Trust Cash Portfolio                                                                   $           200,000
         North Carolina Capital Management Trust Term Portfolio                                                                               150,000
         Short Term Investment Fund (STIF)
         OPEB Trust Fund - State Treasurer                                                                                                     25,000
         OPEB Trust Fund - Other (Please provide a copy of portfolio listing).                                                                150,000
         Hospital Funds Invested with State Treasurer                                                                                          10,000
                                        Name of Custodian
         Government Securities            or Safekeeper                Type of Security             Purchase Amount                   Market Value             Purchase Date            Maturity Date                Yielda
                                      Security Bank &     US Treas. Note                        $              999,270            $           996,875                  6/18/1998                8/15/1999               5.51%
                                         Trust Company
                                      Total from LGC-203 Front- Supplemental                                                                         -
                                                                                               Total by Type*
                                                                                                                                  $           996,875
                                        Name of Custodian
         Government Agencies              or Safekeeper                Type of Security             Purchase Amount                   Market Value             Purchase Date            Maturity Date                Yielda
                                      Security Bank &     FHLB                                               1,000,000                        998,125                  9/26/1998                7/15/2002               5.90%
                                         Trust Company    GNMA                                               1,000,000                        997,325                 11/15/1999                9/30/2000               5.60%
                                      Total from LGC-203 Front- Supplemental                                                                      -
                                                                                               Total by Type*                     $          1,995,450
                                        Name of Custodian
         Commercial Paper                 or Safekeeper                     Issuer                  Purchase Amount                   Maturity Value           Purchase Date            Maturity Date                Yielda
                                      Security Bank &     GE Company                            $              971,442            $          1,000,000                 3/15/1999                8/15/1999               5.00%
                                        Trust Company
                                      Total from LGC-203 Front- Supplemental                                                                         -

                                                                                               Total by Type*                     $          1,000,000
                                        Name of Custodian
         Bankers' Acceptance              or Safekeeper                     Bank                    Purchase Amount                   Maturity Value           Purchase Date            Maturity Date                Yielda
                                      Security Bank &     Trustworthy Bank                      $              967,950            $          1,000,000                 4/15/1999                9/30/1999               6.00%
                                      Total from LGC-203 Front- Supplemental                                                                       -

                                                                                               Total by Type*                     $          1,000,000
                                        Name of Custodian
         Other Investments                or Safekeeper          Type of Investment                 Purchase Amount                   Market Value             Purchase Date            Maturity Date                Yielda

                                      Safe Investment Bk Bd Proceeds Arbitr.                    $              350,000            $           372,000                  6/15/1999                                        5.20%
                                      Total from LGC-203 Front- Supplemental                                                                      -
a
    All yields should be quoted on a bond-equivalent basis.                                    Total by Type*                     $           372,000
V.       Repurchase Agreements (see Instruction 8):                                                                                                              Name of                     Is Master
                       Purchase                                            Type of                                                                               Custodian                  Repo Agree-
     Institution         Date              Maturity Date              Security Purchased            Purchase Amount                   Market Value             or Safekeeper                ment Used?                Yield
Goodfaith Bk             5/15/1999                  7/15/1999           US Treas Note           $              1,000,000          $          1,020,000    3rd Party Bank & Trust                YES                       6.75%
                                      Total from LGC-203 Front- Supplemental                                                                       -

                                                                                               Total by Type*                     $          1,020,000

                                                                 Grand Total of Sect. IV & V Investments:
                                                                 (See Instruction 9)                                          $               6,919,325
LGC 203 (Rev. 06-08), page 2

                                                                         REPORT OF DEPOSITS AND INVESTMENTS

VI.     Analysis of Interest Bearing Checking

                               Financial Institution                                             Amount                                                               Yield
        Goodfaith Bank                                                                             125,000                                                                       3.02%




                                                                    TOTAL                    $     125,000

VII. Summary (see Instruction 11): Please recheck totals.
                                             (1) Cash on hand (total Sect. I)                                                                          $                          250
                                             (2) Total cash on deposit for Dedicated Method (Sect. II)                                                                        426,000
                                             (3) Total cash on deposit for Pooling Method (Sect. III)                                                                         250,000
                                             (4)        Total cash                                                                                                                                       676,250
                                                       (5) Investments (totals Section IV & V)                                                                                                         6,919,325
                                                       (6)        Total cash and investments (lines 4 plus 5)                                                                                          7,595,575


                                                       (7) Less: Unexpended bond and/or note proceeds                                                  $                      372,000
                                                       (8)       Net cash and investments (line 6 minus 7)                                                                               $             7,223,575


VIII. Deposits in Dedicated Method Financial Institutions: (See Instruction 12)                          Required for Banks listed in Section II.

        Name of financial institution                  Goodfaith Bank                                                                                              Securities Pledged as Collateral
                                                                               (a)                 (b)                    (a)-(b)                                  with Third Party Escrow Agent
                                                                          Deposit            FDIC Insured            Uninsured                                                           Market Value at June 30 or
                                                                          Amount               Amount                 Amount                                                                   December 31

        Non-interest bearing deposits (Col. A, Sec. II)              $               1,000   $    100,000        $                  -                      U.S. Treas. & agencies        $               331,000




        Time deposits (Col. B, Sec. II)                                                                                                                    State of N.C.
                                                                                                                                                           /county/municipal             $               100,332
        NOW, SUPERNOW, and Money Market
          deposit accounts (Col. C, Sec. II)                         $          425,000                                                                    Other


            Total Interest Bearing Accounts:                         $          425,000      $    100,000        $          325,000                        Total Pledged:*               $               431,332

Name of Escrow Agent (or Federal Reserve Bank location, if applicable).                       Eligible Bank & Trust Co.                                            * Attach confirmation from depository.
Is there a signed escrow agreement in place (nonapplicable for Federal Reserve Bank)? Circle one                   No                            Yes
Does the unit receive timely confirmations of pledged collateral from the escrow agent? Circle one.                No                            Yes



        Name of financial institution                                                                                                                              Securities Pledged as Collateral
                                                                               (a)                 (b)                    (a)-(b)                                  with Third Party Escrow Agent
                                                                          Deposit            FDIC Insured            Uninsured                                                           Market Value at June 30 or
                                                                          Amount               Amount                 Amount                                                                   December 31

        Non-interest bearing deposits (Col. A, Sec. II)                                      $    100,000
                                                                                                                                                           U.S. Treas. & agencies

        Time deposits (Col. B, Sec. II)                                                                                                                    State of N.C.
                                                                                                                                                           /county/municipal
        NOW, SUPERNOW, and Money Market
          deposit accounts (Col. C, Sec. II)                                                                                                               Other (attach list)


            Total Interest Bearing Accounts:                         $                 -     $    100,000                                                  Total Pledged:*               $                    -

Name of Escrow Agent (or Federal Reserve Bank location, if applicable).                                                                                            * Attach confirmation from depository.
Is there a signed escrow agreement in place (nonapplicable for Federal Reserve Bank)?                    Circle one .                      No    Yes
Does the unit receive timely confirmations of pledged collateral from the escrow agent?                   Circle one .                     No    Yes




                                                       Signature of Official                                                        Date                     Telephone Number (include area code)
CERTIFICATION                                          J. Doe                                                           7/25/2008                                  Number                  Extension
This is to certify that the                            Name of Official                                                                                          910-123-4568                x 106
data contained in this                                 J. Doe                                                                                                    Fax Number (include area code)
report are accurate to the                             Title                                                                                                       Number
best of my knowledge                                   Finance Officer                                                                                           910-123-4569
and belief.                                            Address
                                                       555 Main St., Dogwood, NC 27603                                                          Email Address: j_doe@dogwood.gov
LGC 203-S (Rev. 06-08)


                                                                             SAMPLE
                                                                State of North Carolina
                                                      LOCAL GOVERNMENT COMMISSION
                                            325 North Salisbury Street, Raleigh, North Carolina 27603-1385
                                                   REPORT OF DEPOSITS AND INVESTMENTS
                                                            (As required by G.S. 115C-446)
                                                                                                                                              Day/Month                   Year
School System                Carolina County Public School System                                                               As of:         30-Jun                    2008
                                                                                                                                               (June 30 or December 31, and Year)
INSTRUCTIONS

         1. This report is only for the "special funds of the individual schools." The cash and investments of the administrative unit should be
            reported on the form LGC 203.
         2. Prepare Part II by listing the individual schools since the amount of required collateral must be calculated by individual school. If
            additional space is needed, copy and use as many Part II's as needed or use the supplemental sheets provided.
         3. These funds are not considered "Public Funds" but are trust funds held by the custodian for each individual school. Therefore, the amount
            of deposit insurance available amounts to a total of $100,000 in both demand and time deposits (column 2, 3, and 4 below) for each
            individual school for each financial institution.
         4. Demand deposits are checking accounts which are non-interest bearing.
         5. SUPER NOW and NOW accounts are not considered investments; rather, these are interest earning official depository accounts.
            Certificates of deposit also are deposits and not investments.
         6. List on a separate sheet all investments in column [5]. Show issuer, type of security, purchase date, maturity date, cost value, and market
            value. Attach to LGC 203-S. These investments and the certificates of deposit reported in column [4] should be made on behalf of the
            individual school only by the finance officer of the administrative unit.
         7. Show applicable collateral security information on form LGC 203 in Section VIII. Collateral security covering the school administrative
            unit also covers the individual schools, if applicable, to the extent excess collateralization exists with the same Pool Method financial
            institution.
         8. Prepare and submit an explanation for any school that is under-collateralized.
         9. Foot and cross-foot the cash amounts on each page of Part II and carry forward to the applicable line in Part I - Summary.
      10. Foot and cross-foot Part I - Summary.
      11. Sign certification. Be sure to provide all information requested (name, numbers, address, & email if applicable).
      12. Attach all supplemental date required and submit with LGC 203 for the school administrative unit's own funds.

Part I
         A.      1.   Total number of individual schools.                                          3
                 2.   Number of individual schools with special funds.                                                     3


                                                        [1]                  [2]                   [3]                    [4]                    [5]                      [6]
                                                                                                  NOW
                                                                                               SUPERNOW          Certificates of                Other
                                                  Cash on hand         Demand Deposits          Accounts            Deposit                  Investments                Total
Totals brought forward from
Part II - Page 1 total                        $                  400   $       69,500      $           61,000   $          160,000       $                -      $         290,900
          Page 2 total                                                                                                                                                         -
          Page 3 total                                                                                                                                                         -
          Page 4 total                                                                                                                                                         -
          Page 5 total                                                                                                                                                         -
          Page 6 total                                                                                                                                                         -
          Page 7 total                                                                                                                                                         -
          Page 8 total                                                                                                                                                         -
          Page 9 total                                                                                                                                                         -
Total All Individual Schools                                    $400          $69,500              $61,000                $160,000                        $0              $290,900

* Title of individual responsible for Certificates of Deposit and other Investments.                            Finance Officer

                                             Signature of Official                  Date                            Telephone Number
CERTIFICATION                                J. Doe                          7/25/2008                                 Area Code                Number                 Extension
This is to certify that the                  Name of Official                                                            910                    555                      1111
data contained in this                       J. Doe                                                                   Fax Number
report are accurate to the                   Title                                                                     Area Code                Number
best of my knowledge                         Finance Officer                                                             910                    555                      2222
and belief.                                  Address
                                             111 Main St, Dogwood NC 27603                                           Email Address       j_doe@carolina.gov
LGC 203-S (Rev. 12-02)


                                                                SAMPLE
Part II
                                        [1]            [2]          [3]            [4]              [5]         [6]             [7]
                                                                                                                            Uninsured
                                                                    NOW                                                    Amount [2] +
                                                     Demand      SUPERNOW     Certificates of      Other                    [3] + [4] -
                                    Cash on hand     Deposits     Accounts       Deposit        Investments    Total        $100,000
      Individual School Units
    Name of Financial Institution
Trustworthy Bank:                                                                                                      -   $       -

Dogwood Elementary                             100      12,000        1,000        100,000                      113,100         13,000

Dogwood Middle School                           50      50,000       25,000          50,000                     125,050         25,000

Dogwood High School                            250       7,500       35,000          10,000                      52,750            -

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TOTALS FOR PAGE                               $400     $69,500      $61,000       $160,000                $0   $290,900        $38,000

Manual Preparers: Remember to carry forward each column total to page 1.

				
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