FromrMarsha MHllcan 318 221 4841 10/13/2018 1St38 #104 P.002/005

Affidavit and Revenue Certification

V i \) SOJ. C-l h^ Are Parish

Lbyy] upg/ l iftcitw state J

0 ENTITY NAME

ANNUAL SWORN FINANCIAL STATEMENTS AND CERTIFICATION OF REVENUES $76,000 OR LESS (if applicable)

The annual sworn financial statements are required by Louisiana Revised Statute 24:514 to be fifed with the Legislative Auditor within 90 days after the dose of the fiscal year. The certification of revenues of $75,000 or less, if applicable, is required by Louisiana Revised Statute 24:513(J){1)(c)(i)(aa). *************************

Personally came and appeared before the undersigned authority, l-}pn pr F* ̂ (enter officer name), who. duly sworn, deposes ar^ says that the financial statements herewith given present J fairly th^inancial position oft K)(- ^ (enter entity name) as of

fpAii hf 'O U "ht? V (entity's vear^nd). and ihe results of operations for the year then ended, in accordance with the basis of accounting described within the accompanying financial statements.

. who. duly sworn, deposes and says that $75,000 or less in revenues and other

accordingly, is not required to have an audit for the previously mentioned year

Sworn to and subscribed before me this

fy\

Krisien u. Jackson,' • Notnry ID #66290: "

DeScto Parish, Louisisina My Gonr..misEion Is for Life

• . por Office Use Only Undfr provitJoAt of MM taw. this rapon wfll bocwn* • puWc docuiiMt on Iho

Moo^ fojkMing tfw rolm (totpA copy 0^

•ppropnoto public offid^ tpd bt ovoiioblo lor pubic Intpoeoon M 04 BMon

Soup* offico of tho Louisafla LopiMattvo Auditor ond. whor* •pprpprtait. al »•

offico of tho parish dark of court

-'SMaMOala NOV 02 2016

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Please Complete This Section Officer's Name Officer's Title Address City. Zip Ph: Cell/Land. E-mail

Please return the completed form within 90 davs of vouf entity's vear-end to Louisiana Legislative Auditor -Local Govemmenl Services. Post Office Box 94397. Baton Rouoe. LA 70604-9397 - UfldHedaa/is

From:Marsha MM lie an 316 221 4641 10/13/2016 15:39 #104 P.003/005

Statement A Page 3

(Agency Name)

Statement of Cash Recel For the Year Ended (Year-End)

>lpts and Disbursements

7

General Fund

Other Fund Total

RECEIPTS (Provide Brief Description); 1. 2-3 'j-n'/tresr—^ 4. 5 6. Total receipts (add lines 1 - 6)

9.

$ ijpT-) $

an-

DISBURSEMENTS (Provide Brief Description):

8. 7iY/t,/rytr^

10. 6THBt. PenA'-ty) C-hYT 11.

13. Total Disbursements (add lines 7 -12)

14. Change in fund balance (Lines 6 minu> 13) 15. Fund Balance at beginning of year 16. Fund balance (deficit) at end of year (Add Knes 14-15)

-This amount also goes on line 12, Statement B

m

M Z^L

UM1£.

'-m iUtSl^

%E!EEL

PLEASE RETAIN A COPY OF THE COMPLETED FINANCIAL STATEMENTS FOR YOUR RECORDS

Please return the comoleted form within 90 davs of vour entit/s vear-end to Louisiana Lealstative Auditor -Local Government Services. Post Office 94397. Baton Rouoe. LA 70804«9397 * updated 8/3/16

From:Marsha MiMican 318 221 4841 10/13/2016 16:39 #104 P.004/005

rvM/ NIamof ^ (Agency Name

Balance Sheet, on ̂ (Year-End)

S^teyngnt B Page 4

General Fund

ASSETS (balances at year-end) -Give brief description: 1. Cash and cash equivalents on hand $ t_ 2. Investments (fair value) on hand 3. Office furnishings (Cost of desks, etc) 4. Equipment (Cost of fax machine, etc) 5. Other (brief description) 6. Total Assets (add lines 1

LIABILITIES AND FUND BALANCE (at year-end): 7. Liabilities (give brief description): 8. 9.

» M(n k 10. 11. Total Liabilities (add tines 7 -10)

Other Fund

12. Fund balance (amount from Line 16 on Statement A) 13. Other 14. Total Liabilfties and Fund Balance (add lines 11 -13) $ ijliT $ "

Total

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ZMHZ

PLEASE RETAIN A COPY OF THE COMPLETED FINANCIAL STATEMENTS FOR YOUR RECORDS

return the completed form within 90 dava of vour entity's vear-end to Loulaiana Leaislative Auditor -Local Government Services. Post Office Box 94397. Baton Rouae. LA 70804-9397 - und«iaan«

FromrMarsha Mliiloan 3ia 221 4041 10/13/2016 16;40 #104 P.005/00S

Statement C Pages

(Agency Name) Vl o(' i Schedule of Compensation, Benefits and Other Payments to Agency Head or Chief Executive Officer (Required Form - Please Submit Completed Form Per Attached Instructions)

For the Year Ended

Agency Head Name and Title: I4ph

Purpose Dollar Amount | 1. Salary 1.

2. Benefits-insurance 2.

3. Benefits-retirement 3. 4. Benefits-other (describe) 4.

5. Benefits-other (describe) 6. Benefits-other (describe) e. 7. Gar allowance 7. — 8. Vehicle provided by govemment ornpotM onyourw-2} 8. — 9. Per diem g.

10. Reimbursements 10. -— 11. Travel 11.

12. Registration fees 12.

13. Conference travel 13.

14. Housing 1^- ^

15. Unvouchered expenses (examoie: travel advances, etc.) 15.

16. Special meals 16.

17. Other 17. — 18. TOTAL (enter total of line 1-17) 18. ^ 1

Please check here if the Agency Head does not receive any compensation, benefits, and other payments. (Act 462 of the 2015 Legislative Session allows nongovemmental entities or not-for-profit (quasi-public) entities to report on the Act 706 schedule only those payments to the agency head that are derived from the public funds.)

PLEASE RETAIN A COPY OF THE COMPLETED FINANCIAL STATEMENTS FOR YOUR RECORDS

Local Govemment Services. Post Office Box 94397. Baton Rouge. LA 70804-9397 - updaiai miw