HomeMy WebLinkAboutAnnual 2% Report - Company #5 2010 ANNUAL REPORT ON REVENUES AND EXPENDITURES OF FOREIGN FIRE INSURANCE PRETA IUMS
(See Instructions on Reverse Side)
For the calendar year January 1,20010-December 31,2010
:ALL NUM RS FIN 11IiS REPORT-MUST BE ROU_MED TO THE NEAREST D011AR
Name of Entity:
Type: Fire Department J""'Fire Company Benevolent Association
Fire District ID#(if known) County Whole Located
Name of Fire District or Fire Protection District Where Located(If Applicabte)
Address:__ q'w
City/TowruVillage: �,' L zip
_ MOUNT
Balance:(as of 1/1/10):
Revenues: Foreign Fire Insurance Premiums:
Source: (please list separately)
-- - ----- --- - $ `
Interest on investment of Foreign Fire: $
Total Revenues:
Total Balance and Revenues: C
Expenditures:
( /
Total Expenditures: $ t -70,• J
Balance(as of 1./31/10
f y C�
' ) �
certify that this report is a true and accurate statement of the revenues and expenditures of
Foreign Fire insurance premiums for the calendar year ended 2010.
(Signature): L� L'`G�n' -.z 4w --(Title)-- Lit! - ----
(Telephone Number)—_1G— �Z Z
Tease e-mail, fax or mail report to: afrfjleri�ose.slate.nv.US
Fax: 518-486-3146
Office of the State Comptroller
Division of Local Goveran-te.nt and School Accountability
Data Management Unit
}10 State St. 12-8-C
Albany NY" 12236-0001
1'Clehhone: 318-474-101:1
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