county clerk and purchasing forms - oklahoma · 164 ad valorem tax refund-calendar of claims and...
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County Clerk and Purchasing Forms
Published by The Center for Local Government Technology
and The Oklahoma Cooperative Extension Service
Oklahoma State University Stillwater, Oklahoma
In Cooperation with The Oklahoma State Auditor and Inspector
March 2002
Introduction – How to Use These Forms 1 3/1/02 County Clerk and Purchasing Forms
County Clerk and Purchasing Forms
Table of Contents
Introduction: How to Use These Forms SA&I Form Number Name 112 County Sheriff’s Credit Card Expenditures 114 Bond Register 120-A Full Warranty Lease Agreement for Equipment 120-B Lease Purchase Agreement for Equipment
123 Exhibit KK 127 Certificate and Municipal Order
To County Clerk and County Treasurer 131 County Free Fair Warrant Free Fair Association: State of Oklahoma 140 Monthly Report of Officers 147 Receiving Book 149 County Clerk’s Record of Errors and Assessments 150 Supplemental Estimate
156 Notice of Claim of the State of Oklahoma Ex Rel Oklahoma Employment Security Commission For a Lien for Unemployment Contributions or Taxes
157 Release of Claim of Lien, State of Oklahoma Oklahoma Employment Security Commission
158 Partial Release of Claim of Lien, State of Oklahoma Oklahoma Employment Security Commission
164 Ad Valorem Tax Refund-Calendar of Claims and Voucher Register 165 Certification of Appropriations (School) 166 Certification of Appropriations (City or Town) 166a Schedule of Appropriations Approved (City or Town)
176 Indemnity Bond For Lost or Mislaid Warrant/Vouchers 183 County Clerk’s Warrant Register
195 Official Depository Ticket 201 Financing Statement Reception Record 204 County Clerk’s Receipt
Table of Contents 2 3/1/02 County Clerk and Purchasing Forms
SA&I Form Number Name 205 Drainage Record 210 Receipt (Generic) 213 County Clerk’s Cash Book & Summary Report to County Commissioners 214 Depository Voucher 237 Transfer of Appropriations 247 County Commissioner’s Deed 270 Cash Voucher Claim 307 Request for Approval of State Aid and/or Federal Funds for Schools 308 Cash Fund Estimate of Needs and Request for Appropriation 309 Cash Book Record of Fees Received by County Clerk 312 Law Library Claim
313 Reimbursement to General Fund Account 325 Record of Municipal Judgments 348 Complaint of Erroneous Assessment and Order of Correction 365 Employee’s Salary and Wage Record 382 Assignment of County Claim 388 Officers Request for Supplemental Appropriations 396 Electronic Federal Tax Payment System Advice
397 Resolution for Disposing of Equipment 403 Notice of Refusal 405 Federal Tax Lien Record 413 County Clerk’s Certificate of Returns Filed for Issuance of Tax Deed 415 County Assessors Budget for Visual Inspection Program 425 Affidavit for Filing with Competitive Bid 428 Resolution Appointing Purchasing Officers for Board or Commission 429 Resolution Appointing Purchasing Officers 430 Resolution Determining Maximum Monthly Highway Expenditures 1116 Requisition-Purchase Order-Claim 1117 Travel Claim 1161 County Officers Annual Report (Independent Offices and Agencies)
Table of Contents 3 3/1/02 County Clerk and Purchasing Forms
SA&I Form Number Name 1162 County Officers Annual Report (Dependent Offices and Contractual Agencies) 1291b General Fund Warrant 1291 General Fund Warrant 1292 Building Fund Warrant 1293 Cash Fund Warrant 1294 Highway Cash Fund Warrant 1299 Health Department Fund Warrant 1821 Purchase Order Calendar 2101 Remittance Warrant for Cities and Towns 2102 Remittance Warrant for Schools 2103 Remittance Warrant for Miscellaneous Items 2191 County Clerk’s County Treasurer’s Returns of Sales of Real Estate for Delinquent Tax Together with Record of County Redemption
2192 County Clerk’s Tax Sale: Entered from County Treasurer’s Return of Sale of Real Estate For Delinquent Taxes to Entry to Return of Sale to Individuals Only 2621 Appropriation Ledger and Encumbrance Record
Obligations Salaries or Wages 2622 Appropriation Ledger and Encumbrance
Record Obligations Other Than Salaries or Wages 2691 County Clerk’s Cash Voucher – General Form 2693 County Clerk’s Cash Voucher – Law Library Cash Fund 2742 Pay Roll Claim
3511 Record of Tools, Apparatus, Machinery and Equipment
3512 Summary Report 3651 Weekly Time Record 3652 Earnings Record 1-4001 Affidavit for Contracts and Payments 4030 Receiving Report 1-4040 Invitation to Bid 1-4050 Bid Record 1-4046 Vendor Telephone Quote Request 1-4045 List of Commonly Used Items to County or State Central Purchasing
Table of Contents 4 3/1/02 County Clerk and Purchasing Forms
SA&I Form Number Name 4060 Physician’s Lien
4061 Mechanic’s Lien Journal 4062 Mechanic’s Lien Journal: Direct Index
4063 Mechanic’s Lien Journal: Inverted Index 4064 Mechanic’s Lien statement of Claim
4065 Notice of Filing Lien Statement 4066 Release of Mechanic’s Lien 4067 Judgment Journal 4068 Judgment Journal: Direct Index 4069 Judgment Journal: Inverted Index 4072 Automatic Deposit Transmittal 1-9001 Transfer Document 1-9002 Project Inventory Record 1-9003 Summary Report of Consumable Items 1-9004 Consumable Item Stock Record 1-9005 Fixed Asset Record – Property and Equipment 1-9006 Weekly Warehouse Summary
Introduction – How to Use These Forms 1 3/1/02 County Clerk and Purchasing Forms
Introduction How to Use These Forms
This document includes forms from the Office of the State Auditor and Inspector that are used in the County Clerk’s office and for county purchasing. The forms are listed in numerical order by the form number in the Table of Contents. Simply click on a form number or title and you will be linked directly to that form in this document.
The forms in this document are electronic versions of actual forms, most of which were updated in 2001. You can print the forms out to use as a hard copy to complete. Or, you can complete the forms online by typing the information in the fields provided on the forms and then print out a hard copy. You cannot save the completed copy after you print it out, however.
These forms are included for both use and reference. Some counties now use computer-generated forms in their offices, and those forms may vary slightly from the forms included in this document.
Forms used in the County Clerk’s office that are not from the Office of the State Auditor and Inspector are shown as samples in the Forms Section, Appendix E, of the Handbook for County Clerks of Oklahoma. Most of those forms can be requested from the department, agency, or board that compiles and distributes them.
Introduction – How to Use These Forms 2 3/1/02 County Clerk and Purchasing Forms
S.A . & 1 .
1 12 (1998)
ORIGINAL TO COUNTY COMMISSIONERSCOPY TO SHERIFF
TO THE HONORABLE BOARD OF COUNTY COMMISSIONERS :
I,
, SHERIFF AND/OR DEPUTY OF THE COUNTY AFORESAID, HEREBY CERTIFY, AND BY THE AFFIDAVIT HERETO ATTACHED DO VERIFY, THAT THE FOLLOWINGITEMIZED STATEMENT TRULY REPRESENTS TRAVEL PURSUANT TO THE PROVISIONS OF 19 O .S . SUPP. 1995, § 1506 AND 19 O.S . 199 I , § 1507.
DATED AT
. OKLAHOMA, THIS
DAY OF
COUNTY SHERIFF'S CREDIT CARD EXPENDITURES
COUNTY, OKLAHOMA
SIGNED:
SERVICES NECESSARY FOR TRAVEL OUTOF THE COUNTY BY USE OF ONE ORMORE CREDIT CARDS ISSUED TO THECOUNTY FOR USE BY THE SHERIFFSDEPARTMENT. PURCHASES MADE WITHSUCH CREDIT CARDS SHALL BE LIMITEDTO ACTUAL EXPENSES FOR TRAVEL OUTOF THE COUNTY BY THE COUNTY SHERIFFOR DEPUTIES TO PERFORM THEIROFFICIAL DUTIES ; PROVIDED, SUCH
OR PRIVATE RAILROADS, AIRPLANES,BUSES, RENTAL CARS OR OTHER PUBLICCONVEYANCES, FUEL OIL, MEALS,LODGING, PARKING FEES AND TELEPHONEEXPENSES . THE SHERIFF OF EACHCOUNTY SHALL ISSUE CARDS WHEN SUCHCARDS ARE REQUIRED IN CONNECTIONWITH TRAVEL AND THE SHERIFF ISRESPONSIBLE FOR PROPER USE OF ALLCREDIT CARDS .
SS
I, THE UNDERSIGNED, UPON OATH, DODEPOSE AND SAY THAT I HAVE FULL KNOWLEDGEOF THE WITHIN AND FOREGOING STATEMENT; THATTHE SAID ACCOUNT IS JUST, CORRECT, ANDACCORDING TO LAW ; THAT THE EXPENSESRECEIPTED FOR WERE ACTUALLY ANDNECESSARILY INCURRED IN THE PERFORMANCEOF WORK ACTUALLY DONE BY THE SHERIFF ORDEPUTY SHERIFF SET FORTH IN DETAIL ON THE
OF
COUNTY .
SUBSCRIBED AND SWORN TO BEFORE ME, THISDAY OF, 19
NOTARY PUBLIC OR COUNTY CLERK
MY COMMISSION EXPIRES
APPROVAL OF SHERIFF
THE WITHIN ITEMIZED STATEMENT OFWORK DONE IN THE CASES AS SET FORTH,HAS BEEN CAREFULLY EXAMINED AND FOUNDTO BE IN ACCORD WITH THE SEPARATE ANDADDITIONAL REPORT MADE TO THE BOARD OFCOUNTY COMMISSIONERS OF THE WORKDONE BY MYSELF AND EACH AND ALL OF MYDEPUTIES DURING SAID PERIOD; AND SOFINDING, I HEREBY APPROVE THE WITHINSTATEMENT IN THE AMOUNT OF
SIGNED:CREDIT CARDS MAY BE USED FOR THEPURCHASE OF FUEL, WITHIN THECOUNTY, ON WEEKENDS, NIGHTS ORHOLIDAYS WHEN FUEL CANNOT BE
WITHIN STATEMENT, ITEMIZED AS REQUIRED . -YV WI THAT THE AMOUNT CLAIMED, AFTER
ALLOWING ALL JUST CREDITS, IS NOW DUE ANDWHOLLY UNPAID; AND THAT I AM DULY
OFOKLAHOMA.
SHERIFF
COUNTY, STATE OF
OBTAINED FROM THE VENDOR TO WHOM AUTHORIZED TO MAKE THIS AFFIDAVIT .A BID FOR SUCH FUEL PURCHASE HAS DATED , 19BEEN AWARDED . SIGNED :
SHERIFF"ACTUAL EXPENSES FOR TRAVEL" SHALLMEAN EXPENSES FOR TRAVEL BY PUBLIC (OR DEPUTY)
19 O.S SUPP. 1995, § 1 506 AND19 O.S . 1991 , § 1507
.AFFIDAVIT OF VERIFICATION
STATE OF OKLAHOMA )ANY SHERIFF OR DEPUTY SHERIFF MAYPURCHASE MATERIALS, SUPPLIES OR COUNTY OF )
BONDS OFRegister ofFor what Purpose IssuedRate of InterestNo. of this BondTotal No. of Bonds In this IssueAmount Of this Bond $Date of IssueTotal amount of this Bond Issue $When DueNo. of Coupons attached
Payable atPrices Bonds were sold for $Payable toNet cash received for this Bond Issue $
AMOUNTACCRUEDCOM- TOTALCOUP INT. REMARKSAMOUNT MISSI6N OF BOND PAID PAID
PAID PAID PAID
CouponNo.
1.2.3.4.5.6.7.8.9.10.11.12.13.14.15.16.17.18.19.20.21.22.23.24.25.
Interest
S. A. & I. 114 (2000)
AMOUNT OFCOUPONS WHEN ISSUED WHEN OUT DATE PAID
Dollars Cnts. Mo. Day Yr. Mo. Day Yr. Mo. Day Yr.
S.A.& I. 120-B (2001)
COUNTY, OKLAHOMA
LEASE PURCHASE AGREEMENT FOR EQUIPMENT
THIS AGREEMENT IS MADE ON THIS DAY OF , 20 _, BY AND BETWEEN THE BOARD OF COUNTY COMMISSIONERS
OF COUNTY, OKLAHOMA, DESIGNATED THROUGHOUT THIS AGREEMENT AS THE LESSEE, AND
DESIGNATED THROUGHOUT THIS AGREEMENT AS THE LESSOR.
I. EQUIPMENT
SUBJECT TO THE TERMS AND CONDITIONS AS SET FORTH IN THIS AGREEMENT, THE LESSOR LEASES TO THE LESSEE THE FOLLOWING
DESCRIBED EQUIPMENT, ALL OF WHICH SHALL BE DESIGNATED THROUGHOUT THIS INSTRUMENT AS THE ''EQUIPMENT";
MAKE MODEL DESCRIPTION QUANTITY UNIT PRICE LEASE PURCHASE PRICE
II. PAYMENT OF LEASE PURCHASE INSTALLMENTS
IN CONSIDERATION OF THE AGREEMENT BY THE LESSOR TO LEASE PURCHASE THE EQUIPMENT, THE LESSEE PROMISES TO PAY THE LESSOR,
PERFOR THE EQUIPMENT, THE SUM OF $ , DURING THE TERM OF THIS AGREEMENT OR ANY RENEWAL OF
THE AGREEMENT. IN THE ALTERNATIVE, THE LESSEE PROMISES TO PAY TO THE LESSOR LEASE PAYMENTS AS SET FORTH IN THE LEASE
SCHEDULE WHICH IS ATTACHED TO THIS INSTRUMENT AND WHICH IS INCORPORATED BY REFERENCE NO PAYMENT SHALL BE MADE BY THE
LESSEE UNDER THE TERMS OF THIS AGREEMENT UNLESS THE EQUIPMENT SHALL HAVE BEEN DELIVERED TO THE REQUISITIONING AGENCY AND
IS AT ALL TIMES, EXCEPT WHEN MADE NECESSARY BY AN EMERGENCY, RETAINED BY THE AGENCY.
III. LEASE TERM
THIS LEASE SHALL COMMENCE ON THE DATE THE EQUIPMENT IS ACCEPTED BY THE LESSEE AND SHALL AUTOMATICALLY TERMINATE, UNLESS
RENEWED IN ACCORDANCE WITH THE TERMS SET FORTH BELOW, AT THE END OF THE FISCAL YEAR OF THE STATE OF OKLAHOMA DURING
WHICH THE LEASE IS COMMENCED.
IV. OPTION TO RENEW
THE LESSEE IS HEREBY GRANTED SUCCESSIVE OPTIONS TO RENEW THIS LEASE FOR ADDITIONAL TERMS NOT TO EXCEED ONE FISCAL
YEAR EACH, PLUS ONE FINAL OPTION TO RENEW THIS LEASE FOR A PERIOD OF MONTHS, ALL UPON THE SAME TERMS AND CONDITIONS,
PROVIDED THAT SUCH OPTIONS MAY BE EXERCISED, AS A MATTER OF RIGHT, SOLELY AND EXCLUSIVELY BY THE LESSEE. THE EXERCISE OF
ANY SUCH OPTION SHALL BE ACCOMPLISHED BY THE ISSUANCE OF A PURCHASE ORDER UPON OR WITHIN TEN (I 0) DAYS AFTER THE
EXPIRATION OF THE TERMS OF THIS LEASE OR ANY RENEWAL THEN IN EFFECT.
TITLE TO EQUIPMENTV.
THE EQUIPMENT IS AND SHALL AT ALL TIMES DURING THE TERM OF THIS LEASE AND ANY RENEWAL TERMS REMAIN THE SOLE PROPERTY OF
THE LESSOR AND THE LESSEE SHALL HAVE OR ACQUIRE NO RIGHT, OR TITLE TO THE EQUIPMENT UNTIL THE FINAL PAYMENT IS MADE.
OPTION TO PURCHASEVI.
IN THE EVENT THE LESSEE SHALL HAVE EXERCISED ALL OF ITS OPTIONS FOR RENEWAL OF THIS LEASE AS PROVIDED IN PARAGRAPH IV,
ABOVE, UPON TENDER OF THE LAST LEASE PAYMENT DUE UNDER THE LAST RENEWAL TERM, THE LESSEE SHALL ACQUIRE TITLE TO AND
OWNERSHIP OF THE EQUIPMENT IN THE ALTERNATIVE, THE LESSEE, AT ITS SOLE AND EXCLUSIVE OPTION, MAY PURCHASE THE EQUIPMENT
AT ANY TIME DURING THE TERM OF THIS LEASE OR DURING ANY RENEWAL TERM AS PROVIDED BY PARAGRAPH IV, ABOVE, GIVING WRITTEN
NOTICE TO THE LESSOR OF LESSEE'S INTENT TO PURCHASE ACCOMPANIED BY A SINGLE, FINAL PAYMENT OF $ (IF THE
PURCHASE PRICE IS TO BE REDUCED BY A PERCENTAGE OF THE LEASE PAYMENTS MADE PRIOR TO THE EXERCISE OF THE PURCHASE OPTION,
DESCRIBE FULLY, IN THE SPACE PROVIDED, THE MANNER IN WHICH SUCH REDUCTION SHALL BE COMPUTED. IF ADDITIONAL SPACE IS
NECESSARY, ATTACH A WRITTEN SCHEDULE OF PURCHASE OPTION PRICES WHICH SHALL BE INCORPORATED IN THE TERMS OF THIS
AGREEMENT BY REFERENCE). IN THE EVENT THE LESSEE SHALL EXERCISE ANY OPTION TO PURCHASE THE EQUIPMENT, THE LESSOR ASSIGNS
TO THE LESSEE ALL RIGHTS AND CLAIMS WHICH THE LESSOR MAY HAVE OR ACQUIRE ARISING UNDER THE ANTITRUST LAWS OF THE UNITED
STATES OR OF ANY STATE REGARDING THE EQUIPMENT PURCHASED UNDER THE TERMS OF THIS AGREEMENT.
VII. DELIVERY AND RETURN OF EQUIPMENT
THE LESSOR SHALL BEAR ALL COSTS OF SHIPPING AND DELIVERING THE EQUIPMENT TO THE LESSEE INSTALLATION COSTS, IF ANY, SHALL
BE BORNE BY THE LESSOR. THE EQUIPMENT SHALL BE DELIVERED TO OR INSTALLED AT THE LOCATION DESIGNATED BY THE LESSEE.
VIll. REPAIRS AND MAINTENANCE
THE LESSEE SHALL MAINTAIN THE EQUIPMENT IN GOOD WORKING ORDER AND SHALL MAKE ALL NECESSARY ROUTINE ADJUSTMENTS AND
REPAIRS, AS A RESULT OF FAIR WEAR AND TEAR, ALL AT THE EXPENSE OF THE LESSEE. THE LESSOR AND THE LESSEE MAY PROVIDE FOR
THE MAINTENANCE AND REPAIR OF THE EQUIPMENT BY SEPARATE WRITTEN AGREEMENT, AND, IN THE EVENT THEY MAKE SUCH AGREEMENT, ITS
TERMS SHALL SUPERSEDE AND REPLACE THE PROVISIONS OF THIS PARAGRAPH OF THIS LEASE.
IX. TAXES
THE LESSOR SHALL FORTHWITH PAY ALL TAXES WHICH MAY BE IMPOSED UPON IT WITH RESPECT TO THE EQUIPMENT.
INSURANCEX.
THE LESSEE SHALL OBTAIN AND MAINTAIN FIRE AND EXTENDED COVERAGE CASUALTY INSURANCE COVERING THE EQUIPMENT FROM THE TIME
THE EQUIPMENT IS DELIVERED UNTIL THIS LEASE IS TERMINATED. THIS INSURANCE SHALL BE IN A FOR ACCEPTABLE TO THE LESSOR AND
SHALL INSURE THE FULL VALUE OF THE EQUIPMENT AGAINST THE RISK OF LOSS OR DAMAGE. THE LESSEE SHALL PROVIDE THE LESSOR WITH
WRITTEN NOTICE AT LEAST TEN ( I 0) DAYS PRIOR TO ANY CHANGE IN THE INSURANCE REQUIRED UNDER THE TERMS OF THIS PARAGRAPH.
XI. PATENTS
IN THE EVENT ANY SUIT IS INSTITUTED AGAINST THE LESSEE WHICH IS BASED UPON ANY CLAIM THAT ANY OF THE EQUIPMENT IS IMPLICATED IN
AN INFRINGEMENT OF ANY PROVISION OF UNITED STATES PATENT LAW, THE LESSOR SHALL, AT ITS OWN EXPENSE, DEFEND SUCH SUIT AGAINST
THE LESSEE; PROVIDED, LESSEE PROVIDES THE LESSOR WITH PROMPT NOTICE OF THE INSTITUTION OF SUCH SUIT AND PERMITS THE LESSOR
TO FULLY PARTICIPATE IN THE DEFENSE. THE LESSEE SHALL ALSO RETAIN THE RIGHT TO PARTICIPATE IN SUCH DEFENSE AND SHALL, IN ANY
EVENT, PROVIDE: THE LESSOR WITH ALL AVAILABLE INFORMATION, ASSISTANCE AND AUTHORITY TO ENABLE THE LESSOR TO CONDUCT THE
DEFENSE. NO COMPROMISE OR SETTLEMENT OF SUCH SUIT RESULTING IN A JUDGMENT AGAINST THE LESSEE SHALL OBLIGATE OR BIND THE
52
LESSOR UNLESS THE: LESSOR SHALL HAVE ACCEPTED SUCH COMPROMISE OR SETTLEMENT. THE LESSOR SHALL HAVE THE RIGHT TO ENTER
INTO NEGOTIATIONS FOR AND EFFECT A COMPROMISE OR SETTLEMENT OF SUCH PATENT ACTION, BUT NO SUCH COMPROMISE OR SETTLEMENT
SHALL BE BINDING UPON LESSEE UNLESS APPROVED By LESSEE. SUBJECT ONLY TO THE TERMS OF THIS PARAGRAPH, THE LESSOR SHALL
HOLD THE LESSEE HARMLESS FROM ANY LIABILITY ARISING FROM ANY PATENT SUIT SUCH AS IS DESCRIBED ABOVE. IN THE EVENT ANY OF
THE EQUIPMENT SHALL BE HELD, IN ANY SUIT, TO CONSTITUTE AN INFRINGEMENT OF PATENT LAW, AND ITS USE SHALL BE ENJOINED, THEN
THE LESSOR SHALL, AT ITS SOLE OPTION AND AT THE LESSOR'S EXPENSE:
1. OBTAIN FOR THE LESSEE THE RIGHT TO CONTINUE TO USE THE EQUIPMENT;
2. REPLACE OR MODIFY THE EQUIPMENT IN A MANNER ACCEPTABLE TO THE LESSEE SO THAT THE EQUIPMENT NO LONGER INFRINGES ANY
PROVISION OF PATENT LAW.
XII. FUNDING
NOTWITHSTANDING ANY OTHER PROVISION OF THIS AGREEMENT, THE PARTIES ACKNOWLEDGE AND AGREE THAT FUNDS TO BE PAID BY THE
LESSEE UNDER THE TERMS OF THIS LEASE WILL BE AVAILABLE ONLY AS APPROPRIATED ON A FISCAL YEAR-TO-FISCAL YEAR BASIS BY
PROPERLY CONSTITUTED LEGAL AUTHORITY. IN THE EVENT THAT THE LESSEE DETERMINES THAT SUFFICIENT FUNDS HAVE NOT BEEN
APPROPRIATED To MAKE THE PAYMENTS REQUIRED UNDER THE TERMS OF THIS AGREEMENT, THE OBLIGATIONS OF THE LESSEE UNDER THIS
AGREEMENT SHALL TERMINATE. IN SUCH EVENT, THE LESSEE SHALL GIVE PROMPT WRITTEN NOTICE OF TERMINATION TO THE LESSOR.
XIII. ASSIGNMENT
THE LESSOR MAY, WITH THE PRIOR WRITTEN APPROVAL OF THE LESSEE, ASSIGN ITS RIGHT TO RECEIVE PAYMENT OF LEASE DUE UNDER THE
TERMS OF THIS AGREEMENT. HOWEVER, ANY SUCH ASSIGNMENT SHALL NOT RELIEVE THE LESSOR OF ITS RESPONSIBILITIES TO PERFORM
THE DUTIES AND OBLIGATIONS IMPOSED UPON IT BY THIS AGREEMENT.
XIV. ROAD MACHINERY AND EQUIPMENT
IF THE TERMS OF THIS AGREEMENT ARE IN REGARDS TO ROAD MACHINERY OR EQUIPMENT, THE LESSEE ASSUMES ALL RISK AND LIABILITY FOR
AND SHALL HOLD THE LESSOR HARMLESS FROM ALL DAMAGES TO PROPERTY AND INJURIES AND DEATH TO PERSONS ARISING OUT OF THE
USE, POSSESSION OR TRANSPORTATION OF SAID ROAD MACHINERY OR EQUIPMENT.
XV.
EXCEPT As OTHERWISE PROVIDED IN THE ABOVE TERMS AND CONDITIONS, THIS LEASE, TOGETHER WITH APPLICABLE PURCHASE ORDERS AND
THE INVITATION TO BID, CONSTITUTE THE ENTIRE AGREEMENT OF THE PARTIES. THIS AGREEMENT MAY NOT BE MODIFIED OR TERMINATED
EXCEPT AS PROVIDED IN THE ABOVE TERMS AND CONDITIONS OR BY WRITTEN AGREEMENT OF THE LESSOR AND THE LESSEE. IF ANY
PROVISION OF THIS AGREEMENT SHALL BE DETERMINED TO BE INVALID, IT SHALL BE CONSIDERED AS DELETED FROM THIS AGREEMENT AND NO
REMAINING PROVISION OF THE AGREEMENT SHALL BE DEEMED INVALID.
ENTIRE AGREEMENT OF THE PARTIES AND SEVERABILITY
XVI. CHOICE OF LAW
THIS LEASE SHALL BE GOVERNED IN ALL RESPECTS BY THE LAWS OF THE STATE OF OKLAHOMA. IN THE EVENT ANY LITIGATION SHALL OCCUR
CONCERNING THE TERMS AND CONDITIONS OF THIS LEASE OR THE RIGHTS AND DUTIES OF THE PARTIES, THE PARTIES AGREE: THAT ANY SUCH
SUIT SHALL BE MAINTAINED IN THE DISTRICT COURT IN AND FOR COUNTY (LEASING COUNTY), STATE OF OKLAHOMA.
BOARD OF COUNTY COMMISSIONERS AT
, OKLAHOMA
FOR THE LESSOR:
TITLE
ATTEST:COUNTY CLERK
.
S.A.&I. 123 (2000)EXHIBIT KK
Calculation of Accruals Where a Deficit Exists
County, OklahomaMunicipality
Fill out completely and attach to the budget and estimate of needs
Balance ofUnmaturedAccruals DeductUnmaturedPurpose Balance Yrs. AccrueBonds OutActually Sum ofBonds Due YetTo AccrueOf AnnuallyAccruingIn CashBefore Columns In RemainingBond Issue To To Pay
4-1-20___ Allotted in Levy 2 and 3 Tax Years Run When DueCol.18 Ratio
43 52 761 8
-
CERTIFICATE AND MUNICIPAL ORDERTO COUNTY CLERK AND COUNTY TREASURER
S.A. & 1. 127 (2000)
20Oklahoma,To the County Clerk and County Treasurer of County, Oklahoma.
We, the undersigned, presiding officer and Clerk of the Governing Board of(City, Town, Multi-County Library, Board of Education, Sch. Dist. No.,(state which)
ofin said County, State of Oklahoma, hereby authorize you, from and after the datehereof, for the current term or for the remainder of such current term in caseof appointment to fill vacancy, such authority to continue until the end of suchterm, and no longer, unless sooner revoked, to pay over any public funds col-lected for the aforesaid municipality in accordance with the provisions of 68OkI.St.Ann. § 2923, toAddress , Oklahoma as TREASURER of said Municipalityfor the term stated; and his legal qualifications for said office are herebycertified to be truly and correctly stated as follows:
20 Date Appointed or Re-appointedDate Elected or Re-electedFiled Surety Bond in sum of
as SuretyDollars ( ) with2020Date of Bond(Note 1) Bond Term beginsIf Bond is executed by an authorized Bond Com-Expires 20
pany, give Number of Bond Date Bond was approved by Governing Board20 Record of Approval of Bond and subscribing to oath
underof office recorded in the minutes of the Governing Board at pagedate of 20
Said New Bond is in custody and control of ( Note 2), ordeposited with for safekeeping.was,
(If Treasu rer was Re-elected or Re-appointed, fill out the following:)
Bond No.Bond for previous term executed by20And was for the term beginning 20, and ending
Title 51 OkI.St.Ann. § 4, reading: ''When the incumbent of any office is re-ualify as above required; but his bond shall not be approvedelected he shall q
inaccounted for all public funds and propertyhis control ,under color of his office during the expiring term, toor authority to whom he should account, and the fact and date of such satis-factory exhibit shall be endorsed upon the new bond before its approval'', hasbeen complied with. Said exhibit was prepared byapproved on 20 andI byendorsement made.
Signed and Certified at , Oklahoma, thisday of 20
Presiding officer
Official TitleATTESTINGOFFICER'S SEAL ATTEST:
Attesting Officer
Official Title
Note 1 Extension Certificates ineffective for new term.for each term.
New Bond required(Attorney General)
Treasurer should not have custody of his own Bond. If FinancialNote 2.and Treasurer, Mayor or
other chief officer should have custody.Note 3. See 1 1 OkI.St.Ann. § 8-105, for governing bond for Treasurer of a Town; I I
Okl.St.Ann. §8-101, forCities- 70 Okl.St.Ann. § 5-1 1 5, for Treasurer of a Board of Education, either City orI
Town;and65 Okl.St.Ann § 4-105, for Multi-County Library.
until he has produced or fully
Secretary of City serves both as Clerk
CERTIFICATE AND
MUNICIPAL ORDER
OFName of Municipality
County ofState of Oklahoma, to the County Clerk andCounty TreasurerQualifying
Okla.,as Treasurer of said Municipality.
day ofReceived and Filed this20
County Clerk- County Treasurer,
Deputy
Amount of Bond
Date of Bond 20
Bond Expires 20
SURETIES
COUNTY
.
. For All Salary and Wage Claims
Supply the Following:Total Amount Allowed $
Oklahoma,
Net Amount of Warrant $
Warrant Registered isWithin Balance of Account Exclusive of
Withholdings
Treasurer of Free Fair Board-
S. A. & I. 131 (2000)COUNTY FREE FAIR WARRANT
Free Fair Cash Fund
Claim No. __________ Acct. No._________Dept. ______________________________Purpose____________________________
Funds are available to pay same.
FREE FAIR ASSOCIATIONSTATE OF OKLAHOMA FISCAL YEAR 20___- 20___
Office of Secretary of:Warrant No.
Payment No.
TO THE TREASURER OFTHE FREE FAIR BOARD 20
Pay to the order of:Dollars
Attest: By my own signature I attest the genuine signature of the presiding officer of the Board, and further truly certify that the purpose stated is, in summary, as disclosed on the face of the claim, and that the amount thereof is within the sum available thereof after providing for all claims and contracts pending, which are of record in my office.
Secretary
LabelOut of the COUNTY FREE FAIR CASH FUNDfrom monies lawfully accruing to said funds forthe aforesaid fiscal year after due registrationand endorsement.
BY ORDER OFTHE FREE FAIR BOARD
President, Board of Directors
Amount $
Fed Tax $________State Tax $________Soc Sec. $________Medicare $________Insurance $________Other $________
MONTHLY REPORT OF OFFICERS
CountyOFFICE OF
The following report showing, by classes, the amount of receipts and disbursements for the month of , with balanceof cash on hand at beginning and close of' said months, is respectfully submitted.
BALANCEBALANCECLASSIFICATION OF ACCOUNTS Cash on Hand atCash on Hand at CANCELLED
Close ofTransfersBeginning of VouchersReceived this Transfers VOUCHERSMonthMonth OutIssuedInMonth
S. A. & I. 140 (2000)
20
RECONCILEMENT
The following is a reconcilement of the withinreport with the report of the Countyfor the month of
Beginning Depository Balance $
ADD: Collections $
Cancelled Vouchers $
SUBTRACT:Vouchers Issued $
Ending Depository Balance $
ADD: Vouchers Issued,Not Reg $
Deposits inTransit- Beginning $
Ending $
TREASURER Errors $$
$
$
TREASURER'S BALANCE $
( Officer )MONTHLY REPORT FOR THE MONTH OF
APPROVED BY THE BOARD OF COUNTY COMMISSIONERSTHIS DAY OF
20
Member
Member
Chairman
20
20
COUNTY CLERK'S Error
MONTHLY REPORT
Of
For month ending on
Reconciled and Filed this
of
Officer
I, _________________________ , Officer
duly elected, qualified and acting in and
for _________________ County
Oklahoma, do solemnly swear that the
above is true and correct report of all
fees charged and collected in my office
for the month ending on the _____ day
of_____________ , 20____
Subscribed and sworn to before me this
_____ day of _______________ , 20___
My Commission Expires:______________
County, Okla.
_____ day of
20__
____ day
20 _____
Officer
Notary Public
RECEIVING BOOKRECORDING.RECORDED.DATE OF FILING NATURE OF * FEEGRANTEEGRANTORNumber INSTRUMENT.
S. A. & I. 147 (1985)
A.M.P.M.YR. MO. DAY HR. BOOK PAGE DOLS. CTS.
RECEIVING BOOKDoc. AMT. DATE OF
DELIVERYRECStamps TO WHOM DELIVERED ADDRESSFROM WHOM RECEIVEDMO.DOLS. CTS. DOLS. CTS. DAY YR.
-
S.A.&I.149 (2000) Note: Allot to each School District one or more pages and open a separate account for each years Tax
DATE ISSUEDTWP.OR CITY DESCRIPTION Sec. ACRES SchoolTwp. Rgs.TO WHOM ISSUEDYr.DayCertificate Mo.
or DistrictNo.Lot
County Clerk's Record of Errors and Assessments
S.A.&I. 150 (2000)SUPPLEMENTAL ESTIMATE
FOR
Town or(County City Board of Education)
of COUNTY, OKLAHOMA
FUND at the close of the monthWith Exhibits showing the Financial Condition of the
ending ,20
And a Statement of Additional Needs for the remainder of the
Fiscal Year ending June 30, 20
To the County Excise Board
County of , State of Oklahoma
Greetings:Pursuant to the requirements of 68 Okla.St.Ann. § 3021, we herewith submit for your consideration the within Statement of
Fund of thethe Fiscal Condition of the , County of , Stateof Oklahoma, for that portion of the current fiscal year beginning July 1, 20 , and ending with the close of business on the lastday of the month of , together with an itemized statement of balances in appropriations now,20considered unnecessary or dispensable in view of greater needs, and an itemized statement of additional needs considered essential
As to the Countiesin the proper conduct of said municipality for the remainder of the current fiscal year ending June 30, 20and Cities, find attached hereto certificate of publication as required by said Section 3021. We further certify that the estimate ofincome from sources other than Ad Valorem Tax for the remainder of the current fiscal year is reasonably probable of collectionbefore June 30th next, and that such estimate is based on the estimated income other than ad valorem tax as fixed by the exciseboard for the current fiscal year, after excluding any estimate of such income to be received from prior or back ad valorem taxas to which the date of sale for delinquency has elapsed.
We further certify that the aggregate amount of said proposed additional and supplemental appropriations, when added to theoriginal appropriations for the fiscal year, is not in excess of the income and revenue provided and accumulated for this current fiscalyear, that Officers in charge of Departments affected by proposed cancellations have been notified of such proposals, and that nopart of the revenue of this or a previous year against which there are any outstanding claims, contracts or warrants has been includedin this Supplemental Estimate.
Dated at day of ,20, Oklahoma, this
(Member) (Chairman, President or Mayor)
Attest:(Clerk) (Member)
CERTIFICATE OF TRUE STATEMENT OF FINANCIAL CONDITION AND CASH ON HANDWe, the undersigned, do hereby solemnly swear or affirm that the within Exhibits ''D," "F," ''M'' and ''Y'' reflect a true and
FUND for each of the stated Fiscal Accounts of thecorrect statement of the condition of the(municipality), of ,20 , that weCounty, Oklahoma, at the close of business onhave no knowledge or record of any claims or contracts pending against the Balances of Appropriations proposed for cancellation;and that all of said statements are in accordance with and as shown by the records of our respective officers, each, so help me God.
Treasurer's signature: Clerk's signature:(Treasurer) (Clerk)
day of day ofSubscribed and sworn to before me this the Subscribed and sworn to before me this the,20 ,20
(County Clerk or Notary Public)(County Clerk or Notary Public)
(UNLESS BOTH CLERK AND TREASURER SWEAR TO THIS CERTIFICATE, IT SHALL NOT BE APPROVED)
Filed this the day of ,20 , County Clerk
NOTE:--The same officers shall as law required to sign the Financial Statement and Estimate of Needs forthissigna county or any subdivision thereto when the same is filed in July with the County Excise Board.
application
FINANCIAL STATEMENT SHOWING CONDITION OF CURRENTAND ESTIMATE OF SUPPLEMENTAL AND ADDITIONAL NEEDS OF THE
S.A.& I. 150 (2001)
Schedule 1 Cancellation of Appropriations PUBLISH
1 2 3Acct DEPARTMENT PURPOSE BALANCE PROPOSED CANCELED BY
AVAILABLE CANCELLATIONS EXCISE BOARD
Total
Schedule 2 Supplemental and Additional Estimated Needs PUBLISH
Acct 1 2 3DEPARTMENT PURPOSE AMOUNT PUBLISHED BY APPROVED BY
GOV. BOARD EXCISE BOARDREQUESTED
Exhibit ''F'' Miscellaneous Revenue Other than Current2l(Note 1) 3(Note 2)
ACTUALLY COLL- BALANCE COLL-SOURCE OF REVENUE ESTIMATESECTIBLE APP'DAPPROVED ECTED TO DATEInclude estimate of revenue from ALL sources except current ad valorem tax.
BY EXCISE BOARD IN CAPTION BY GOV. BOARD
None after Nov. 1.
21 Estimate of Miscellaneous Revenue Exclusive of Back Tax
22 Transfer Column 2 Total Into Column 3
Current Tax Receipts into Delinquency Reserve (D-4 minus S-13)23
24 Total Collected and Probable for the year
30 Total Already Applied
Surplus Available (Not to Exceed Surplus on D-29)31NOTE: 1. Include all lawful estimates such as original and state aid estimate by Excise Board for Schools.
2. No authority for remainder of year more than the balance of lawfully approved miscellaneous estimate.
General Government Additional Provision for Interest on Warrants
1 Surplus of Prior Year (20 ) after providing for all obligations thereof.
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19 Total Estimated (Col. 1) and Collected (Col. 2) and Uncollected (Col. 3.)
20 Deduct Item 1, Column 1 (Surplus from Delinquent Tax)
25 Deduct: 1. Original Estimate of Miscellaneous Revenue (F-19, Column 1)
26 20and(Y-11)2. Surplus Applied in Supplemental dated
27 20and (Y-12) 3. Surplus Applied in Supplemental dated
28 4. Deficiency in ''Plan of Financing'' Appropriations (Y-14)and
29
FUND ON LAST DAY OF MONTH OF ,20OF COUNTY, OKLAHOMA.
Exhibit ''M'' Appropriation Summary
1 2 3FOR FOR TOTALWARRANTS INTEREST
12 Net Approved AppropriationsExhibit ''Y'' Method of Financing Appropriations
Equalized Certified and Extended 1 2 3Mills DETAIL TOTAL EXTENSIONLevy CertifiedAssessed Valuation S
5 Balance Gross Proceeds of Levy free of Protests
Deduct: Reserve at6 % for Delinquencies (1/1 1 if at 10%)
13 Total Finance free of Protests to Cover Exhibit ''M'', Line 11, Column 3
Note any deficiency in Plan of Finance (Any Excess of M-11-3 over Y-13) (See F-28)14
Exhibit ''D'' Current Cash
Receipts, Disbursements and Balance Sheet Condition DETAIL TOTAL EXTENSION
7 Total Balance and Receipts
11 Total Disbursements
(Publish) BALANCE SHEETBalance Cash on Hand on date shown in caption above
Current Assets
Net Current Tax Available Free of all Protests and Reserves (Y-7)13
14 Deduct Current tax Apportioned (D-4)
15 Net Balance Current Tax in Process of Collection (To Column 3)
16 Balance of Original Estimate of Miscellaneous Income (F-19, Column 3)
17 Total Assets
20 Balance Appropriations Available (To Column 3)
23 Deduct Interest Provision Used to Date (D-9)
26
Surplus --- (If Correctly Prepared Will Agree With F-3 1)29
1.Publish all Items Below Line 11 of Exhibit ''D'' in Counties and Cities2.Include No Unclaimed Protest Tax Refunds on Which the 6-Months Expired After July 1
1 2 3
1 Original Estimate ''Made and Approved'' as filed with State Auditor
2 20Increase due to Supplemental Appropriation dated
3 20Increase due to Supplemental Appropriation dated
4
5 Total Appropriations Approved
6 Cancellations and Reserves
7 Reserved for Pending Appropriation Protest on Items not included in 68 Old.St.Ann., § 3032
8 Canceled by Court Order
9 Canceled by Excise Board under authority of 68 Old. St.Ann., § 3023
10
11 Total Cancellation and Reserves
1 Gross Proceeds of Levy Certified to State Auditor2 Deduct: 1. Gross Proceeds of Mills Canceled by Excise Board 68 Okl.St.Ann., § 3023
3 and 2. Gross Proceeds of Mills Canceled by Court Order
4 Mills for Levy Protests still pendingand 3. Gross Proceeds of
7 Net Tax Available to Finance Appropriations
8 Surplus Cash of Prior Year on hand July 1 ( Examine Tax Court J. E. for adjustments)
9 Protest Tax Refund Unclaimed fully released Jul 1 (Examine Tax Court J. E. for adjustments)
10 Estimate of all Misc. Incomes other than Current Tax (Exhibit ''F'', Column 1, Line 19)
11 20Surplus Collections added by Supplement dated
12 Surplus Collections added by Supplement dated 20
1 Cash Surplus of Prior Year Actually on Hand July 1 (Y-8)
2 Released Unclaimed Protest Tax Refund on Hand July 1 (Note 2) (Y-9)
3
4 Current Tax Apportioned
5 Miscellaneous Income Other Than Current Tax Apportioned (F-19, Column 2)
6
8 Current Warrants Paid
9 Interest Paid Thereon
10
12
Current Liabilities and Reserves18 Appropriations Available for Warrant Issues (M-11, Column 1)
19 Deduct Warrants Issued to Date in Caption
21 Current Warrants Outstanding on Date in Caption (D-19 Less D-8)
22 Provision Made for Interest on Current Warrants (M-1 1, Column 2)
24 Residue of Interest Provision (If More is Needed, Enter in Schedule 2)
25
27 Total Liabilities and Reserves
28 Deficit
PROOF OF PUBLICATIONAFFIDAVIT
STATE OF OKLAHOMA, COUNTY OF , ssPersonally appeared before me, the undersigned Notary Public, I
Clerk of of the County and State aforesaid, who being first duly sworn according to law, deposesand says--That he complied with the law by having Exhibits ''D'' Balance Sheet, and Schedules 1 and 2, of the within Financial Statementand Estimate published as required by law in at least one issue of the
, a copy of which publisheda weekly-daily newspaper published in the City-Town ofstatement and estimate, together with proof of publication thereof, is hereto attached marked Exhibit ''A,'' and made a part hereof. Inevidence whereof the Affiant has subscribed hereto under oath.
ClerkSubscribed and sworn to before me this day of ,20My commission expires ,20 , Notary Public
CERTIFICATE OF EXCISE BOARDSTATE OF OKLAHOMA, , ss:
We, the undersigned, Members of the Excise Board of said County and State, do hereby certify that we have examined andcarefully considered the application and proposal of the Governing Board of
of the same County and State aforesaid, for additional and supplemental appropriations for certain current expense purposes for theremainder of the fiscal year ending June 30, 20 , the financial statement submitted therewith as of the month ending
,20 , and the list of appropriations and parts thereof proposed for cancellation, after hearing any protests againstsuch proposed cancellations.
We rely on the sworn statements of the Clerk and of the Treasurer and of the Governing Board of the with-in-named municipalitythat the revenues already received have been properly credited to the several Fiscal Year Accounts, that all warrant issues have beenproperly charged thereto or paid therefrom, and that no unpaid claims or contracts are pending against the balances of Appropriationssubmitted for cancellation.
We find, on analysis of the within Financial Statements, that the available surplus revenue already accrued and which is subjectto supplementary appropriations under title 28 Okla.St.Ann. § 3021, is as follows:
Canceled Current Appropriation Balances, as per Schedule 1, column 3Current Revenues Actually Collected in excess of previous Appropriated Estimates, Exhibit ''D,'' line 29, $...
Fund use, Schedule 2Total Surplus Approved and Appropriated to Current $Wherefore, we have and do order cancellation of Appropriation Items as shown in last column of Schedule 1, and we hereby
appropriate the Current Revenues released thereby, together with Current Surplus Assets disclosed to Current Purposes, and we haveand do hereby approve and make additional and supplemental Appropriations as listed in column 3 of Schedule 2 in the total sum of
which is within the total amount of surplus Revenue accrued as scheduled. The Secretary of the County Excise Board is$hereby ordered to certify the same to the Clerk of the within-named municipality or subdivision of the State of Oklahoma, who is herebyauthorized to enter the same upon his records, to notify his Treasurer of this action, and to make said funds available to his GoverningBoard.Dated at day of, Oklahoma, this , 20Attest: SignedI
Secretary of County Excise Board Chairman of County Excise Board
Member of County Excise Board
Member of County Excise Board
$
NOTICE OF CLAIM OF THE STATE OF OKLAHOMAEX REL OKLAHOMA EMPLOYMENT SECURITY COMMISSION
NOTICE is hereby given that:
Indebted to the State of Oklahoma ex rel Oklahoma Employment Security Commission for the following
AMOUNTPERIOD
Qtr.Qtr.Qtr.Qtr.Qtr.Qtr.Qtr.Qtr.Qtr.Qtr.Qtr.Qtr.Qt r.Qtr.Qtr.Ctr.Qtr.
together with interest thereon at the rate of 1% per month from the respective delinquent dates as provided
by law and the regulations of the said Commission; and,
NOTICE is further given that a lien in favor of the State of Oklahoma is claimed upon all franchises,
property and rights to property, whether real or personal now belonging to, or hereafter acquired by said
tax debtor, irrespective of whether such property is employed by such person in the prosecution of said busi-
ness or is now in the hands of an assignee, trustee, or receiver for the benefit of creditors, under and by
.
day ofDATED Oklahoma City, Oklahoma, this
STATE OF OKLAHOMA EX RELOKLAHOMA EMPLOYMENT SECURITY COMMISSION
By
Official Title
$
$TOTAL
S.A. & I. 156 (2000)
FOR A LIEN FOR UNEMPLOYMENT CONTRIBUTIONS OR TAXES
virtue of provisions of 40 Okl.St.Ann. § 3-303.
20
unpaid, unemployment contributions or taxes:
Office of the County ClerkCounty
Oklahoma
Notice Of the Claim of the State of Oklahomaexrel Oklahoma Employment Security Commissionfor a Lien for Unemployment Contributions orTaxes,
Against
Filed this day of, 20
County Clerk
ByDeputy
STATE OF OKLAHOMA )OKLAHOMA COUNTY ) ss
The undersigned notary public in and for said State, hereby certifies that the withinnamed to me known to be theof the Oklahoma Employment Security Commission, appeared before me and. acknowledged to methat he executed the above and foregoing instrument as his own free and voluntary act and deed,
and as the free and voluntary act and deed of the Oklahoma Employment Security Commission.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal this day
Notary Public
of_____________________ , 20____.
My Commission Expires:
(Seal)
STATE OF OKLAHOMA ssCOUNTY)
I, the undersigned, County Clerk of said County and State, do hereby certify that thewithin and foregoing notice of claim of lien for Unemployment Contributions or Taxes, is a true and
day ofcorrect copy of the original notice of claim filed in my office on the.
dayIN WITNESS WHEREOF, I have hereunto set my hand and official seal thisof
(SEAL) County Clerk
20
20
STATE OF OKLAHOMA ssCOUNTY)
I, the undersigned, County Clerk of said County and State, do hereby certify that thewithin and foregoing notice of claim of lien for Unemployment Contributions or Taxes, is a true and
day ofcorrect copy of the original notice of claim filed in my office on the.
dayIN WITNESS WHEREOF, I have hereunto set my hand and official seal thisof
(SEAL) County Clerk
20
20
CERTIFICATE OF TRUE COPY
STATE OF OKLAHOMA ssCOUNTY)
I, the undersigned, County Clerk of said County and State, do hereby certify that thewithin and foregoing notice of claim of lien for Unemployment Contributions or Taxes, is a true and
day ofcorrect copy of the original notice of claim filed in my office on the.
dayIN WITNESS WHEREOF, I have hereunto set my hand and official seal thisof
(SEAL) County Clerk
20
20
S. A. & I. 157 (2000) STATE OF OKLAHOMAOKLAHOMA EMPLOYMENT SECURITY COMMISSION
RELEASE of the Claim of the )Oklahoma Employment SecurityCommission for a Lien for UnemploymentContributions or Taxes,
) Instrument No.) Tax Lien No.Against )) Pg.Tax Lien Record Vol.
))Tax Debtor
RELEASE OF CLAIM OF LIEN
The undersigned hereby acknowledges receipt of $ , the
amount due on unemployment compensation taxes for the period set forth in the
Notice of the Claim of the Oklahoma Employment Security Commission for a Lien
for Unemployment Contributions or Taxes filed against said tax debtor on the
day of , which sum is received and accepted in full
payment and satisfaction of all liens and Claims under said notice, and the
undersigned does hereby release, acquit and forever discharge said tax debtor
of and from all liability by reason of said notice.
This release shall be filed in the office of the County Clerk of
and the Clerk is hereby authorizedCounty, Oklahoma,
and directed to enter this release on the records of said office and to re-
lease the said notice of record on payment of his fees by said tax debtors.
day ofDated this
OKLAHOMA EMPLOYMENT SECURITY COMMISSION
BY
Chief of Contributions
, 20
.20,
Office of the County ClerkCounty ofState of Oklahoma
Release of Claim of the Oklahoma Employment Security Commission for a Lien for Unemployment Contributions or Taxes
Against
Filed this day of
County Clerk
ByDeputy
NOTE: Before this release is filed allfees for the filing of the notice as wellas the release must he paid by the taxdebtor.
, 20 .
STATE OF OKLAHOMACOUNTY OF
) ss)
That the undersigned notary public in and for said State, herebycertifies that the within namedtheEmployment Security Commission, appeared before me and acknowledged to me that
executed the above and foregoing instrument as histhe saidown free and voluntary act and deed and as the free and voluntary act anddeed of the Oklahoma Employment Security Commission
IN WITNESS WHEREOF, I have hereunto set my hand and official sealthis day of(SEAL) Notary Public
My Commission expires:
20, .
to me known to be as foresaid, of the Oklahoma
S. A.&I. 158 (2000)STATE OF OKLAHOMA
OKLAHOMA EMPLOYMENT SECURITY COMMISSIONWILL ROGERS MEMORIAL OFFICE BUILDING
OKLAHOMA CITY, OKLAHOMA 73105
)PARTIAL RELEASE of the Claim of the OklahomaEmployment Security Commission for a Lien forUnemployment Contributions or Taxes.
)Instrument No,)
)Tax Lien NoAgainst )
)Tax Lien Record Vol.)
)))
Tax Debtor )
PARTIAL RELEASE OF CLAIM OF LIEN
For and in consideration -of
receipt of which is hereby acknowledged, the State of Oklahoma ex rel Oklahoma Employment Security Commission doeshereby release the claim set forth in the Notice of the Claim of the Oklahoma Employment Security Commission for a Lien for
day ofunemployment contributions or taxes, filed against said tax debtor on the
20 , insofar as the said taxes or contributions are a lien upon the following described property situated in
County, State of Oklahoma to wit:
The Oklahoma Employment Security Commission hereby expressly reserves the said lien aforesaid against all otherproperty of the said tax debtor.
This release shall be filed in the office of the County Clerk of
County, Oklahoma, and the clerk is hereby directed and authorized to enter this release on the records of the said office uponthe payment of his fees by the said tax debtor.
Dated this day of 20
OKLAHOMA EMPLOYMENT SECURITY COMMISSION
Chief of Contributions
Page ____
Office of tile County Clerk
County of
State of Oklahoma
Partial Release of Claim of the OklahomaEmployment Security Commission for a Lienfor Unemployment Contributions or Taxes.
Against
day ofFiled this
I
County Clerk
By Deputy
NOTE: Before this release is filed all fees for the filing ofthe notice as well as the release must be paid by the taxdebtor.
STATE OF OKLAHOMACOUNTY OF
) ss)
That the undersigned notary public in and for said State, hereby certifies that the within named, to me known to be the
as aforesaid, of the Oklahoma Employment Security Commission , appeared before and acknowledged to me that thesaid executed the above and foregoing instrument as his own free andvoluntary act and deed, and as the free and voluntary act and deed of the Oklahoma Employment Security Commission.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal this day of
(SEAL)Notary Public
My Commission expires:
20 ____.
ADVALOREM TAX REFUND-CALENDAR OF CLAIMS AND VOUCHER REGISTER
S.A.&I. 164 (2000) UNDER INITIATIVE PETITION NO.
NO. OFCLAIM TAXAMOUNTDATE FILED VOUCHER RECEIPTED FOR BYCLAIMANT RECEIPTOF VOUCHERNo. MO. Day REFUND ISSUEDNUMBERYear Yr.
Tax
100
CERTIFICATE OF APPROPRIATIONSWhite Original to the ClerkYellow Duplicate to the TreasurerPink Triplicate for Co. Clerk's Files
FOR THE FISCAL YEAR ENDING JUNE 30, 20
CountyTo the Clerk and Treasurer,Board of Education of School District No
This is to certify that the County Excise Board relying upon the financial statements contained in your Budgetary request has madeappropriations authorized by statute for the operation and maintenance of your School District for the ensuing fiscal year. To meet therequirements for the several items of appropriation as approved they have accordingly appropriated all available surpluses, revenues, and theproceeds of ad valorem tax levies, as hereinafter set out.
GENERAL FUNDAMOUNT AMOUNTBUDGET FINANCEPURPOSE OF APPROPRIATION APPROPRT'DAPPROVED
AmountNo.Dist. County Appr't'dTrsf'dNo.
Supplemental Text Books$Total Gross Requirements (1)
BUILDING FUNDAMOUNT AMOUNTPURPOSE OF APPROPRIATION BUDGET FINANCE APPROPRT'DAPPROVED
.
SINKING FUNDAMOUNT AMOUNTBUDGET FINANCEPURPOSE OF APPROPRIATION APPROPRT'DAPPROVED
Surplus$Total Requirements per Budget $
Ad valorem Tax Levies RequiredValuations Excluding Homestead ExemptionsGeneral Fund$ MillsThis CountyBuilding Fund MillsJoint withSinking Fund MillsJoint with
Joint withJoint with
$Total Valuations Certified
Oklahoma
day of
Certified at(Signed)
Secretary of the County Excise Board
20____
S.A. & I. 165 (2000)
Total Appropriated $(2)
1. Current Expense $ Surplus Cash of Prior Year $2. Capital Outlay3. Reimbursement for Lunch Room4. Vo-Tech Transportation Reimbursement
5. Interest Earned6.7. Reserve for Interest on Warrants County 4 Mill Levy
County Apportionment (Mtg. Tax)
TRANSFERS PAYABLE Resale Property Fund
State School Land EarningsGross Production TaxMotor Vehicle Collections for RoadsR.E.A. Tax
Foundation & Incentive (State Aid)Drivers Education
Reimbursement for Vocational SalariesTotal Approved for Transfers Motor Vehicle Collections for Co-Govt.Grand Total Appropriations Mobile Homes License
Delinquency Reserves Tax Stamps
Transportation GrantStaff Development
Chapter IChapter 11
Ad Valorem Tax Required (1)
Label
Erection of School Buildings $ Surplus Cash Prior Year $Repair of School Buildings Protest Tax RefundsPurchase of Furniture Estimated Miscel. Receipts
Interest on Warrants Tax in process of CollectionAd valorem Tax Required
TotalDelinquency ReserveTotal Gross Requirements (2) $ Total Appropriated (2) S
Delinquency Reserve Ad valorem Tax Required II
Total Gross Requirements (3) $ Total Appropriated (3) $
S.A.& I. No. 166- (2000)CERTIFICATE OF APPROPRIATIONSWhite Original to the Clerk
Yellow Duplicate to the TreasurerPink Triplicate for Co. Clerk's Files
FOR THE FISCAL YEAR ENDING JUNE 30, 20
CountyTo the Clerk and Treasurer,City or Town of
This is to certify that the County Excise Board relying upon the financial statements contained in yourBudgetary request has made appropriations authorized by statute for the operation and maintenance of yourCity or Town for the ensuing fiscal year. To meet the requirements for the several items of appropriation as ap-proved they have accordingly appropriated all available surpluses, revenues, and the proceeds of ad valoremtax levies, as hereinafter set out.
GENERAL FUND BUILDING FUNDAMT. APPROVED AMT. APPROVEDPURPOSE OF APPROPRIATIONPURPOSE OF APPROPRIATION OR APPROPRT'D OR APPROPRT'D
I. Erection of Public Buildings2.
Delinquent ReserveTotal Gross Requirements (2)
Surplus CashPrior Tax in process of Col.Ad valorem Tax required
Total Appropriated tomeet Gross Requirements (2)
Revenue AppropriatedSINKING FUNDOccupation Tax
Requirements provided forDog Tax and Dog pound feesInterest on Bonds
Revenue Appropriated
Ad valorem Tax Levies RequiredValuations Excluding HomesteadThis County General Fund Mills
Building FundCo.Joint with. MillsSinking FundTotal Valuations Certified Mills
Oklahoma, this day ofCertified at
SignedSecretary of the County Excise Board
20
Excess of Assets overLiabilities (Surplus)
Surplus Cash of Prior Years Ad valorem Tax RequiredAd valorem Tax Required
Total Appropriated to meet Total Appropriated to meet$General Fund Requirements (1) Sinking Fund Requirements (3)
(Use for Town) $ $1. Personal Services2. Maintenance and Operation 3. Interest on Warrants3. Capital Outlay Total Budget Provided for
(Use for City)Total Appropriations for all Revenue AppropriatedDepartments - Schedule attached
Interest on WarrantsTotal Budget provided for
Delinquency ReserveTotal Gross Requirements (1)
Police FinesGarbage Disposal Fees Accrual on unmatured BondsSewer Connection Fees Accrual on Prepaid JudgmentsProperty Rentals Accrual on Unpaid JudgmentsInspection Fees Interest on Unpaid JudgmentsFees for Issuance of Permits Commission to Fiscal AgencyAlcoholic Beverage Excise Tax
Unpaid Past Due Coupons
Light & Power Utility Revenue Unpaid Past Due BondsWater Utility Revenue
Special Accounts Total Sinking Fund RequirementsPark Department FeesCemetery Burial Permits Delinquency ReserveCemetery Other Fees Total Gross Requirements forLibrary Fees Sinking Fund (3)
SCHEDULE OF APPROPRIATIONS APPROVED
CITY OR DEPARTMENTALIZED TOWN OF
FISCAL YEAR ENDING JUNE 30, 20
PersonalTotal Maintenance CapitalDEPARTMENT OtherServices Outlay& Operation Appropr'n
(1) (2) (3)
$ $$ $ $Governing Board
Municipal CourtPolice DepartmentFire Department
Board of Health
Park Department
Library BoardBudget
Municipal Hospital
$ $Total
Itemization of special appropriations under Column (4) aboveName of Appropriations
Note-This form required to be completed and attached to S.A.& I. form No. 166for all Cities and departmentalized Towns
S. A. & I. No. 166a (2000)
(4)
General Government
City ClerkCity TreasurerCity Attorney
City EngineerStreet Department
Sanitary Department
Utility DepartmentWaterUtility DepartmentLight & Power
Cemetery BudgetAirport Budget
$ $ $
Department Amount
S.A.& I. No. 1 76 (2002)
INDEMNITY BOND FOR LOST OR MISLAID CHECKS/WARRANTS/VOUCHERSSTATE OF OKLAHOMA )
)SS.COUNTY OF )
KNOW ALL MEN BY THESE PRESENTS THAT WE, , OF I
(PRINCIPAL)OKLAHOMA AND , OF , OKLAHOMA
(CITY OF SURETY)(NAME OF SURETY COMPANY, IF SURETY REQUIRED)
AS SURETY/SURETIES, ARE HELD AND FIRMLY BOUND UNTO THE TREASURER OF(NAME OF MUNICIPAL SUBDIVISION)
TO BE PAID TO SAID TREASURER OFOKLAHOMA IN THE PRINCIPAL SUM OF $(DOUBLE AMOUNT OF LOST CHECK/WARRANT/VOUCHER)
COUNTY, OKLAHOMA FOR WHICH PAYMENT WELL AND TRULY TO BE MADE, WE BIND OURSELVES,
AND EACH OF OUR HEIRS, EXECUTORS, ADMINISTRATORS AND ASSIGNEES, JOINTLY AND SEVERALLY BY THESE
PRESENTS.
THE CONDITIONS OF THIS OBLIGATION ARE SUCH THAT WHEREAS A CERTAIN CHECK, WARRANTOR VOUCHER
ISOF THE FUND OF THE SERIESNO. IN THE SUM OF $
ALLEGED TO HAVE BEEN LOST, DESTROYED OR MISLAID.
NOW IF THE SAID OBLIGOR SHALL WELL AND TRULY SAVE HARMLESS AND INDEMNIFY SAID OBLIGEE AGAINST
ALL CLAIMS BY ANY PERSON ON ACCOUNT OF SAID CHECK, WARRANT OR VOUCHER AND AGAINST ALL COSTS AND
EXPENSES BY REASON OF SUCH CLAIM, THEN THIS OBLIGATION SHALL BE NULL AND VOID.
WITNESS MY HAND THIS THE DAY OF , 20
(PRINCIPAL)
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
AFFIDAVIT
, DO HEREBY STATE THAT I AM THE PAYEE (OR LEGAL AGENT OF THE PAYEE) SHOWNI ,
ON CHECK/WARRANT/VOUCHER NO. OF THE FUND, OF THE SERIES IN THE SUM OF $
ISSUED BY THE DAY OF, OKLAHOMA, DATED THE
I FURTHER STATE THAT SAID CHECK/WARRANT/VOUCHER IS LOST AND CANNOT BE FOUND AND, 20
I REQUEST THAT THE CLERK ISSUE A DUPLICATE CHECK/WARRANT/VOUCHER IN THE ABOVE INDICATED AMOUNT.
(PAYEE)
, 20DAY OFSUBSCRIBED AND SWORN TO BEFORE ME, THIS
(SEAL)
(NOTARY PUBLIC)MY COMMISSION EXPIRES:
APPROVAL:APPROVED THIS DAY OF , 20
TREASURER OF
(TREASURER)*************************************************************************************
STATE OF OKLAHOMA, COUNTY OF , SS:
I, THE UNDERSIGNED , THE DULY ELECTED OFFICER
OF , BEING THE SURETY ON THE FOREGOING BOND, BEING FIRST DULY SWORN, UPON OATH, STATE: THATSAID CORPORATION IS CHARTERED UNDER THE STATUTES OF THE STATE OF OKLAHOMA, SUBJECT TO EXECUTION UNDER THE LAWS
) OVEROF THE STATE OF OKLAHOMA, REASONABLY WORTH AT LEAST DOLLARS ($AND ABOVE ALL THE SAID CORPORATION'S JUST DEBTS, LIABILITIES AND LEGAL EXEMPTIONS.
(OFFICER)
SUBSCRIBED AND SWORN TO BEFORE ME THIS DAY OF , 20
(SEAL)
NOTARY PUBLIC IN AND FOR THE STATE OF OKLAHOMA
MY COMMISSION EXPIRES:
COUNTY CLERK'S WARRANT REGISTER
Date of Issue DATE PAIDPaymentTotalWarrant InterestClaimTO WHOM ISSUED
WarrantNumberPaidNumber PaidNumber
-...
AMOUNT BROUGHT FORWARD20_____
Fund
Mo. Yr.
S. A. & I. 183 (2000)
Day
Series for Fiscal Year ending June 30, 20____
ofAmount Receipt for Warrant
Signature of Claimant
S.A.& I. 195 (2000)
STATE OF OKLAHOMAOFFICIAL DEPOSITORY TICKET
Ticket NoCounty ofTo The County Treasurer:
The within list of checks and cash is to cover receipts of my office for the day of
ByDeputy
LIST OF CHECKS, DRAFTS, MONEY ORDERSOR CASHIER'S CHECKS
TOTALS
. this the day ofReceived the above deposit aggregating $and credited account of
Account No , County TreasurerBy , DeputyRegister No
NOTE: List all Checks, Drafts, Money Orders or Cashier's Checks in separate groups.
20___
CurrencySilver
Amounts
20
Official Title
By Whom Drawn Bank Drawn On Location of Bank
S. A. & 1. 201 (2000)
FINANCING STATEMENT RECEPTION RECORD
DATE OF FILING TerminationSECURED PARTY FEEDEBTORNO. NumberYear Mo. Day Hr.
This document is ruled and lined.
TerminationDate
Day Yr.Mo.
S.A.&I. 204 (2000)
COUNTY CLERK'S RECEIPT No., Oklahoma
Date: 20
Received of $
Dollars
For fees or items as shown inmargin hereofCash
Money OrderCounty Clerk
Total $Deputy
,
Recorded Instruments
Filed Instruments
Lien SearchPhotographic Copies
Certificates and SealsAssignments Tax Certificates
Recording Plat
License RegistrationsM & M Liens
Notices and Exhibits
Judgments
Underground Facilities
Miscellaneous
Total Fees
Documentary Stamp
Total
Check
DRAINAGE RECORDS.A.& I. 205 (2000)
PLAT OF DRAINAGE DISTRICT NO.COUNTY OF
Showing Location of Property in question
Section Township Range
12 9
Label
Label
Label
.
DRAINAGE RECORD
#205 CONT.
NO.
AMOUNT
(OFFICE OR BOARD)
COUNTYSTATE OF OKLAHOMA
, OKLAHOMA
RECEIVED OF' $
PURPOSEMETHOD OF PAYMENT
ByCASH CHECKMONEY ORDER OFFICER DEPUTY
RECEIPTDescription
20
Dollars
S. A. & I. 210 (2000)
COUNTY CLERK'S CASH BOOK & SUMMARY REPORT TO COUNTY COMMISSIONERS
S.A. & I. 213 (2000)
RefundMiscellaneousLiensDocumen-
Total
Certificate & Seal FictitiousCertlfl-Date Photo- Lien JudgmentsFinancingRecorded tary Partnership Notice &SearchcationscopiesAmountSourceStatements Acknowledge-Instruments BondsStamps
Tax SaleFiling ExhibitsmentAssign. Amount VoucherMo. Day Yr.
RECONCILEMENT
Depository balance beginning of month
ADD: Collections
TOTAL $
SUBTRACT: Vouchers Issued
Depository balance of month
, County Clerk of
County, hereby certifythat this report Is a true and correct report of all fees chargedand collected In my office for the month ending on the
day of
, County Clerk
By , Deputy
Approved by the Board of County Commissioners this
day of
, Chairman
, Member
, Member
$
$
$
$
20
20,
I,
AMOUNT
DRAWN FOR -Payable Through
TOTAL
S.A. & I. 214 (2000)
DEPOSITORY VOUCHERIssued for
OFFICE OF COUNTY NO.
To TheCounty Treasurer
As Official Depository
Pay to the order of: $
County Treasurer
DeputyREGISTERED NO
20____PLEASE CASH AT ONCE
as shown in the margin hereof
OFFICER
Deputy
SPECS: These are all pre-numbered LIGHTLY BOUND-PERFORATED(1) Changes to be made in title to appropriate county office(2) The bank number must be imprinted very clearly, that it can be machine read(3) The name of the depository bank should be printed in the space under "Payable Through"(4) The voucher should never exceed 8 1/4" x 3 1/4", otherwise cannot be handled through the Federal Reserve Machines
(a page 3 l/4 " x 8 l/4 " 24 or 28 lb. bond safety paper DUPLICATE )
Dollars
NOTE: THE TOTAL OF COLUMN 5, EXHIBIT "B" MAY NOT EXCEED THE TOTAL OF COLUMN 6, EXHIBIT "A"
EXHIBIT "A" UNENCUMBERED APPROPRIATIONS ACCOUNT BALANCES ON ___________________ 20______, FOR
THE FISCAL YEAR 20____ 20____, AND STATEMENT OF BALANCES CONSENTED TO FOR CANCELLATIONS.
Name of Appropriation Account
Office orDepartment
Unemcub'dBal. on dateShown
Consentto CancelBy Officer
Cancelled By Board
2. 4. 5. 6.1.
Acct.No.
EXHIBIT "B"ADDITIONAL APPROPRIATIONS REQUESTED FOR REMAINDER OF FISCAL YEAR ENDING JUNE 30, 20___.
_________________________ Fund ____________________________ _________________________Office or Department Municipality
Acct. No.
Purpose or Nameof Appropriation Account
Office orDepartment
AmountRequested Board
3.Approved By
4. 5.2.1.
3.
I
S. A. & 1. 237 (2000)TRANSFER OF APPROPRIATIONS
Fund ofWithin the
Governmental Agency
20Fiscal Year 20County, Oklahoma
REQUEST FOR ADDITIONAL NEEDS
To the Honorable Governing Board:Gentlemen: Due to an emergency which has arisen in my office or department, and under authority of68 Okl.St.Ann. § 3021, I hereby request additional appropriations for current expense in the above namedfund, detailed as to amounts requested in each appropriation account in Exhibit "B''. I further state that I haveobtained written consent to the cancellation of appropriations balances detailed in Exhibit ''A", Column 5 asevidenced by the signatures of the officers and/or department heads appearing in Schedule 2 below. Ifurther state that the reasons for the emergency are
Respectfully submitted this day of , 20
Officer or Head of Department
Officer or Head of Department
Officer or Head of Department
Officer or Head of Department
CONSENT TO CANCELI, we. or either of us, the undersigned officers and/or heads of departments of the above named governmental agency
do hereby consent to the cancellation of appropriation balances detailed in Column 5, Exhibit ''A''. in so far as the appro-priations and balances submitted for cancellation and subject to my or our individual control.
CONSENT TO CANCEL AND REQUEST FOR ADDITIONAL NEEDS
-(For Governing Boards)
dayor Clerk of said board and signed at Oklahoma, this
of
NOTICE TO COUNTY EXCISE BOARD
Pursuant to 62 Okl.St.Ann. § 461, the undersigned County Clerk of County,
Oklahoma, gives notice to the County Excise Board that there has been a transfer of
appropriations following the approval by the governing board of
ATTEST:County Clerk
Date
Title
Title
Officer or Head of Department
Officer or Head of Department
Officer or Head of Department
Officer or Head of Department
Title
Title
Title
Title
We, the undersigned Governing Board named in the caption hereof, under authority of 68 Okl.St.Ann. § 3021, do hereby consent to the cancellation of the appropriation balances detailed in Column 5, Exhibit "A", and request that the revenues released thereby be appropriated to the accounts detailed in Exhibit "B". We further state that this request is made due to an emergency which has arisen in the department of the above named governmental agency and that the reasons for the emergency are
Done in a meeting of the Governing Board of the said governmental agency and recorded in the minutes of the Secretary
, 20
Secretary or Clerk
Chairman
(Schedule 2)
(Schedule 1)
Title
Title
(Schedule 3)
S.A. & I. No. 247 (2002)
COUNTY COMMISSIONERS' DEEDWHEREAS, THE COUNTY TREASURER OF COUNTY, STATE OF OKLAHOMA, ON
THE DAY OF 20 ,SOLD SEPARATELY AND SINGLY, IN THE MANNER PROVIDED
BID IN FOR THE REALBY LAW, ANDESTATE HEREINAFTER DESCRIBED, AND
WHEREAS, ALL PROCEEDINGS, NOTICES AND DUTIES PROVIDED, REQUIRED AND IMPOSED BY LAW PREREQUISITE TO THE VESTING OF AUTHORITY IN SAID BOARD OF COUNTY COMMISSIONERS TO EXECUTE THISCOMMISSIONERS' DEED HAVE BEEN FOLLOWED, GIVEN, COMPLIED WITH AND PERFORMED, AND
WHEREAS, THE SAID BOARD OF COUNTY COMMISSIONERS IS NOW BY LAW VESTED WITH POWER ANDAUTHORITY TO EXECUTE THIS COMMISSIONER'S DEED,
DAY OF 20NOW, THEREFORE, THIS INDENTURE, MADE THIS , BETWEEN
THE STATE OF OKLAHOMA, BY , CHAIRPERSON OF THE BOARD OF COUNTY
COMMISSIONERS, OF COUNTY, OF THE FIRST PART, AND I
OF THE SECOND PART, WITNESSETH, THAT THE SAID PARTY OF THE FIRST PART FOR AND IN CONSIDERATION OF THE
PREMISED AND THE TOTAL SUM PAID, TO-WIT: DOLLARS ($ ), HATH
GRANTED, BARGAINED AND SOLD, AND BY THESE PRESENTS DOTH GRANT, BARGAIN, SELL AND CONVEY TO THE SAID
PARTY OF THE SECOND PART, HIS (OR HER) HEIRS, EXECUTORS, ADMINISTRATORS AND ASSIGNS, FOREVER, THE
FOLLOWING SEPARATELY DESCRIBED TRACTS, PARCELS, OR LOTS OF LAND SO SOLD SEPARATELY AND SINGLY FOR THE
AMOUNT BID IN THE TOTAL SUM SET OPPOSITE EACH, ALL OF SAID TRACTS, PARCELS, OR LOTS OF LAND BEING
LOCATED IN
COUNTY, OKLAHOMA, TO-WIT:
SUBDIVISION:
DESCRIFFION AMOUNTSEC. TwP.CITY - TOWN OR OR RANGE (BID ON
LOT BLK. EACH)
TOTAL
TO HAVE AND TO HOLD SAID TRACTS AND PARCELS OF LAND WITH THE APPURTENANCES THERETO BELONGINGTO SAID PARTY OF THE SECOND PART, HIS (OR HER) HEIRS, EXECUTORS, ADMINISTRATORS AND ASSIGNS, FOREVER, INAS FULL AND AMPLE MANNER AS SAID BOARD OF COUNTY COMMISSIONERS OF SAID COUNTY IS EMPOWERED BY LAW TOSELL THE SAME.
IN TESTIMONY THE BOARD COUNTYOF COMMISSIONERS OF SAID COUNTYWHEREOF,
OF , STATE OF OKLAHOMA, HAS SET THEIR HANDS AND SEAL THE DAY AND
YEAR AFORESAID.STATE OF OKLAHOMA
ATFEST:
(SEAL)
ByCHAIRPERSON
COMMISSIONER
COMMISSIONER
ACKNOWLEDGMENT
STATE OF OKLAHOMASS:
COUNTY OF
AY OFBEFORE ME, THE UNDERSIGNED, A NOTARY PUBLIC, IN AND FOR THIS STATE, ON THIS
PERSONALLY APPEAREDI I
I TO ME KNOWN TO BE THE CHAIRPERSON OF THE BOARD OF COUNTY
COMMISSIONERS OF COUNTY, OKLAHOMA, AND THE IDENTICAL PERSON
WHO EXECUTED THE WITHIN AND FOREGOING INSTRUMENT AND CONVEYANCE OF LAND, AND ACKNOWLEDGED TO ME
THAT (S)HE EXECUTED THE SAME IN HIS (OR HER) CAPACITY AS CHAIRPERSON OF THE BOARD OF COUNTY
COMMISSIONERS OF COUNTY, OKLAHOMA, AS HIS (OR HER) FREE AND
VOLUNTARY ACT AND DEED AS SUCH, AND AS THE FREE AND VOLUNTARY ACT AND DEED OF
COUNTY, AND THE STATE OF OKLAHOMA, FOR THE USES AND PURPOSES THEREIN SET
FORTH.
WITNESS MY HAND AND NOTARIAL SEAL THE DAY AND YEAR ABOVE WRITTEN.
NOTARY PUBLIC(OR COUNTY CLERK)(SEAL)MY COMMISSION EXPIRES
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S.A.&I. 270 (2000)
COUNTY, OKLAHOMA
THE COUNTY TREASURER
NAME ADDRESS
DISALLOWEDDATE AMOUNTCLAIMED
The County Clerk Is hereby authorized to mail Voucher issued in payment of this Claim to Claimant at address hereinabove stated.
I, the undersigned, upon oath, do depose and say that I have full knowledge of the above and foregoing account; that the said accountis just, correct, due and according to law; that the amount claimed, after allowing all just credits, is now due and wholly unpaid; andthat I am authorized to make this affidavit, so help me God.
Subscribed and sworn to before me this Claimant.
day ofCLERK'S APPROVAL
AUDITED AND APPROVED FOR - - $
20
Total
Oklahoma,In Account With
BY CLERK
CASH VOUCHER CLAIM
DETAIL20
20
County Clerk
CASH VOUCHER CLAIM8-20½
NOTICEVoucher No.Claim No. BY This form is to be used only in making claims for
money received through error by the County Treas-urer, and for assessor's penalty, surveyor's fees,side-walk tax, old law paving and other special im-provement taxes required to be paid over to securityholder, and to such other Money as may come intothe hands of the treasurer as is not required to bepaid out on bond, coupon or warrant.
AgainstThe Treasurer
OF
COUNTY
OKLAHOMA
19 Okl.St.Ann. § 691 reads as follows:FOR
''All money collected through error by the countytreasurer, and all other funds of whatsoever kind thatshall come into his possession by virtue of office, ex-cept such as is required to be disbursed on warrant,bond, Interest coupon or depository voucher, shall berefunded or paid out as the case may be, only onvoucher issued by the county clerk. No county treas-
FILED
urer shall, after having filed with the county clerkany report of collections, make any refund of any partthereof, except in the manner as herein provided.County Clerk.
ByDeputy
AMOUNT CLAIMED $
ASSIGNMENTAUDITED AND ALLOWED
For value received, I hereby assign the within claimFor $
and, authorize the county clerk to issue voucher inpayment of sa me to said assignee.ACCOUNT:
This day of day of
County Clerk.
20
20 Dated this 20
Claimant
"
To:
REQUEST FOR APPROVAL OF STATE AID AND/OR FEDERAL FUNDS FOR SCHOOLSFUND
307(2000)S.A.&I. School District No.
To the County Clerk of County, State of Oklahoma:We, the undersigned, duly qualified and acting officers of the
Governing Board of the aforementioned school district of said County andState hereby certify that the notice of approval of the following Stateand/or Federal Funds has been received and is currently on file in theschool's business office:
Total
We, further certify that these funds are in addition to and in excessof the State and/or Federal Funds previously appropriated for the schooldistrict. We, therefore, request that the school's appropriations beincreased by the following amounts:
Requested CurrentPrior Added ByPURPOSE OF ITEMOF APPROPRIATIONS
ApprovedApplicationApproved CountyAppropriations Clerkof Funds Appropriations
1 Current Expense
2. Interest Reserve
20day ofSubmitted, by order of the Board, this
ClerkPresident of the BoardCERTIFICATE OF COUNTY CLERK
STATE OF OKLAHOMA, COUNTY OF , SS:I, the duly qualified and acting County Clerk in and for the saidState, do hereby certify that I have added the requested amounts to the appropriationsof the school district in the manner requested by the School's Board of Education.
.Done at day ofOklahoma, this ,20
County Clerk
(SEAL) By Deputy
1.2.3.4.5.6.7.
.
3.
.
Grand Total
County and
Cash Fund Estimate of Needs and Request for AppropriationCASH FUND
OF MUNICIPALITYCounty, City or Town
Certificate of County TreasurerI, hereby certify that I have received and now hold, In actual cash actually on hand available for and subject to
ofcash fund ofappropriation to the County, Oklahoma, derivedfrom the following designated sources and restricted by statute to expenditure for the purposes for which such fund wascreated as follows, to-wit:
The Sum of $FromThe Sum of $FromThe Sum of $FromThe Sum of $From
From The Sum of $The Sum of $From
From The Sum of $From The Sum of $
The Sum of $FromFrom The Sum of $
TOTAL unappropriated available for purposes of said fund $
Said sums Include no part of any revenues heretofore reported and appropriated for the purposes of said cash fund and arebeing held subject to action by the County Excise Board.
day of TreasurerCertified to this
By Deputy
County, OklahomaTo the Excise Board of
This Is to certify that, pursuant to the 5th proviso of 62Okl.St. Ann. § 331 there has accrued In the Treasury and Is
hereinbefore certified to as available for appropriation and use in the cash fund of the aforesaidmunicipality, an amount of money equal to or greater than the total estimated needs hereinafter set out, that the Itemizedpurposes hereinafter named are lawful purposes to which said fun may be put, and we hereby respectfully request approvaland appropriation therefore as follows, to-wit:
AMOUNT APPROVED BYPURPOSEACCT. NO.REQUESTED EXCISE BOARD
Done by order of the Governing Board of said Municipality and recorded In the minutes of the Clerk at
day ofOklahoma, thisATTEST:
Clerk or Secretary to Governing Board.
Certificate of the County Excise Board, State of Oklahoma, ss.County of
We, the undersigned duly qualified and acting members of the Excise Board in aforesaid County and State, havingconsidered the estimate of needs submitted by the Governing Board of said Municipality and, to the extent that the same waswithin the amount of cash available for such purpose, we have approved the several items of appropriation ascertained to befor purpose authorized by law and have indicated the items and amounts for approval in the last column.
day of, Oklahoma, thisDone at
COUNTY EXCISE BOARD OF THE AFORESAID COUNTY AND STATEATTEST:
Chairman
Member
MemberSecretary of County Excise Board
FOR THE
S. A. & I. 308 (2000)
20
20
20
CASH BOOKRECORD OF FEES RECEIVED BY COUNTY CLERK
S. A. & I. 309 (1985)
i - COUNTY CLERK'S FEESCOLLECTIONS REGISTER OF DEEOS FEESRECORDED INSTRUMENTS
(Reception Daily Totalsj MISCELLANEOUSCertificateFINANCING STATEMENTS Assign-ment and SealFiling No's DocumentReception No's Fictl.ofDATE (Inclusive) (Inclusive)Receipt Copies tiousTax Sale Tax Under. LienFROM WHOM RECEIVED Acknow-No. Certi- Partner. groundAmount StampsAmount Searchshipficate Facil-To FromFrom ledgmentsTo Certif. itiesicates
.
BALANCE (OR FOOTINGS) FORWARD
I
Mo. Day Yr.
-
I
.
-
-
LIENS OFFICIAL DEPOSITORY
COUNTY CLERK'S LIEN FEE ACCOUNTDEPOSITORY ACCOUNT DISBURSEMENTSTOTAL. RECONCILELien JudgmentDAILY MENTNumber Bond NoticeApplication ExhibitAmount Date Paidand COLLECTIONS Amountto file or WITHDeposits Pages VoucherTO WHOM PAIDPostageRelease Bond PaidDEPOSITED DEPOSITORYNo.
Mo. Day Yr.
LAW LIBRARY CLAIMCOUNTY, OKLAHOMA
THE BOARD OF LAW LIBRARY TRUSTEESOF COUNTY, OKLAHOMA.
In Account WithName Address.
DATE DISALLOWED BYItemize In Detail AMOUNT CLAIMEDBOARD OF TRUSTEES
TOTALTHE COUNTY CLERK IS HEREBY AUTHORIZED TO MAIL VOUCHER ISSUED IN PAYMENT OF THIS CLAIM TO CLAIMANT AT ADDRESS HEREIN STATED.
I, the undersigned, upon oath, do depose and say that I have fullCERTIFICATE OF APPROVAL AND ORDER OF PAYMENTknowledge of the above and foregoing account; that the said accountis just, correct, due and according to law; that the amount claimedafter allowing all credits, is now due and wholly unpaid; and that Iam authorized to make this affidavit, so help me God.
This is to certify that the within and foregoing claim was dulyconsidered by the Board of Law Library Trustees at a proper meetingwith a quorum present, and, upon verification and authenticationthereof, was approved to the extent above noted; wherefor the CountyClerk is hereby authorized and directed to issue his cash voucher tosaid claimant or his assignee in payment thereof in the amount of
Claimant$
Subscribed and sworn to before me this day ofCOUNTY BOARD OF LAW LIBRARY
Dated and entered in County Clerk or Notary Public, Presidentminutes of the BoardMy commission expires, Secretary
___________________________ Okla. _________________ 20______
20
TRUSTEES
20____
20____
S. A. & I. 312 (2000)
REIMBURSEMENT TO GENERAL FUND ACCOUNT62 Okl.St.Ann. § 335
To: County Clerk and County Treasurer
FOR THE GENERAL FUND ACCOUNTOF COUNTY AS PER RESOLUTIONNO. ADOPTED BY THE COUNTYBOARD OF COUNTY COMMISSIONERS ON
Date
The following reimbursement is to be credited to the following General Fund Account.
Receipt DateGeneral Fund Co. Treasurer Source of AmountAccount and Miscellaneous Reimbursement
Receipt No.No.
1,Office or Head of Department Title
of County, hereby certify this ADVICE is true andcorrect as reflected by the appropriate reimbursements received by this office and request the fundsreceived be credited to the aforementioned General Fund Account in accordance with the resolutionadopted by the Board of County Commissioners and 62 Okl.St.Ann. § 335.
Date Officer or Head of Department Title
Received and credited to the General Fund of the county.
Date County TreasurerDeputy
Appropriately credited to the General Fund Account
County ClerkDateDeputy
Original to be filled out by department receiving reimbursement and distributed to county clerk.Copy to county treasurer.Copy to officer or head of department
S. A. & I. 313 (2000)
I, ,
-
RECORD OF MUNICIPAL JUDGMENTS (Defendant Municipality)IN FAVOR OF
Secretary to Excise Board, or Clerk of
County, State of Oklahoma PlaintiffCase No. . by Court
AddressDate Journal Entry Received Date of Journal Entry .
Judgment, subject to Interest .
Court Costs, If added
Total Judgment For:
For Clerk of any County, City, Town, or Board of Education; and for Secretary to Excise Board
Judgment For:
RECORD OF ESTIMATES AND SINKING FUND PROVISION FOR THIS JUDGMENT
INTEREST COMPUTED IN BUDGETON UNPAID PRINCIPAL SUM
PROVIDED FOR IN BUDGET ALLOWED BY TAX COURT
From Date To Date TOTAL TOTALInterest For JudgmentFor Judgment InterestMo.
RECORD OF CLAIMS FILED. APPROVALS HAD. AND PAYMENTS MADE ON THIS JUDGMENTTAX-MATURITY BALANCES
LIMITING PAYMENTSEVIDENCE OF PAYMENT BY REPORT-RETURNS OF TREASURER TO CLERK
APPROVED BYCOURT CLERK'S CLAIM FILEDFOR JUDGMENT DUE MUNICIPAL CLERK
Current Second Third AmountAmount Date ApprovedPaidClaimed April lst Yr.Day
.
20 20
S.A. & I. 325 (2000)
(If Judgment held invalidby court, make no further levies.)
Payment forbidden until 30 days after First Provision by Budget becomes final and upheld. If Judgment is held invalid, no payment may legally be made, and such Judgment may not belevied for until revived in original Court. If first budgetary provision not stricken by protest, payment can be made within Cash in Sinking Fund not needed (Const. Art. 10, Sec. 28)until reimbursement can be made by Judgment levy. 62 Okl.St.Ann. § 365.3.
Assignment Date: __________________ 20 ______ To: _________________ 20 ______
Date: __________________ 20 ______ To: _________________ 20 ______Date: __________________ 20 ______ To: _________________ 20 ______
$
$
$
Mo.April 1stApril 1st AmountApproved
Treasurer'sCheck No.
TAXABLEYEAR REMARKS
Day Yr. Mo. Day Yr.
Date of ClaimDay Yr.Mo.
Date PaidDayMo. Yr.
S.A.& I. 348 (2002)
COMPLAINT OF ERRONEOUS ASSESSMENTAND ORDER OF CORRECTION
NoSS.STATE OF OKLAHOMA, COUNTY OF
1, THE UNDERSIGNED, BEING FIRST DULY SWORN, DEPOSE AND SAY THAT I AM THE LAWFUL AND SOLE OWNER, OR THE DULYAUTHORIZED AGENT OR ATTORNEY FOR THE OWNER, OF THE FOLLOWING DESCRIBED PROPERTY ASSESSED AND ENTERED UPON THE TAX BOOKSOF SAID COUNTY AND THAT CERTAIN TAXES HAVE BEEN ASSESSED, LEVIED AND EXTENDED UPON SAID TAX BOOKS AGAINST SAID PROPERTY, ORAGAINST THE PERSON NAMED IN SUCH ENTRY AND IN THIS COMPLAINT AND AFFIDAVIT, THAT THE TAXES ARE UNPAID, OR THAT THE TAX HAS BEEN
, AS EVIDENCED BY RECEIPT No 1 20 THAT THE, DATEDPAID IN THE AMOUNT OF $ASSESSMENT AND TAX SHOULD BE CORRECTED AS SHOWN, AND, CERTIFICATE OF ERROR AND ORDER TO CORRECT THE TAX ROLLS ISSUED, OR,REFUND MADE, AS THE CASE MAY BE, IN THE MANNER PROVIDED BY LAW.
FOR THE TAXABLE YEAR 20 As ENTERED As SHOULD BE As ORDERED
By BOARDAPPEARS UPON THE TAX ROLLS OF SAID YEAR AT BOOK PAGE PER COMPLAINT
PERSONAL OR REAL PROPERTY ASSESSMENT
DESCRIBED THUS'
IF CITY OR TOWN LOTS, STATE WHETHER IMPROVED OR VACANT
LEGAL DESCRIPTION: SECTION OR LOT (LOTS IF IMPROVED)
TOWNSHIP NUMBER
RANGE OR BLOCK NUMBER
NUMBER OF ACRES (RURAL)
LOCATED IN: TOWNSHIP, CITY OR TOWN ADDITION
SCHOOL DISTRICT No. (NOW AND PRIOR)
GROSS OR TOTAL VALUATION OF PROPERTY ASSESSED $ $ $
EXEMPTIONS OTHER THAN HOMESTEAD (LODGE USE, ETC.) $ $ $
EXEMPTION FOR HOMESTEAD DEDUCTION ALLOWED TIMELY $ $ $
NET VALUATION AFTER DEDUCTION FOR ALL EXEMPTIONS $ $ $
TAX HOMESTEAD DEDUCTION SUBJECT TO (OLD DEBT LEVY) $ $ $
TAX ON NET VALUATION (ALL LEVIES IN TAXING AREAS) $ $ $
PENALTY FOR DELINQUENT ASSESSMENT (PERSONAL TAX) $ $ $
SPECIAL TAX FOR $ $ $
TOTAL OF ALL TAX CHARGES $ $ $
AFFIANT FURTHER STATES THAT THE ERROR, MORE SPECIFICALLY DESCRIBED, IS AS FOLLOWS'
AND IS ONE OF THE SPECIFIC CLASSES OF ERRORS (No OF THOSE ENUMERATED) SPECIFICALLY AUTHORIZED TO BE CORRECTED BYTHE PROCEDURES SET OUT IN 68 OKL.ST.ANN. § 287 1 , AND INCLUDED AS A PART HEREOF AS FULLY AS IF REASSERTED HEREIN:
WHEREFORE AFFIANT PRAYS THAT THE HONORABLE BOARD OF TAX ROLL CORRECTIONS OF SAID COUNTY RECEIVE THIS COMPLAINTAND PETITION FOR CORRECTION AND TO ORDER CORRECTION OF THE SAME, OR TO SET DOWN A DAY CERTAIN FOR HEARING THEREON AND SOADVISE THE COMPLAINANT AND AFFIANT HEREIN, CAUSE THE COUNTY TREASURER AND COUNTY ASSESSOR TO APPEAR WITH THEIR TAX BOOKSAND ASSESSMENT RECORDS IN RELATION TO SAID PROPERTY AND TAX, REDUCE ALL TESTIMONY TO WRITING, AND DO ALL OTHER THINGSNEEDFUL AND EXPEDIENT FOR PROPER, LAWFUL AND JUST CORRECTION.
SIGNED
ByAGENT OR ATTORNEY
BEFORE ME, THE UNDERSIGNED, PERSONALLY APPEAREDKNOWN TO ME TO BE THE IDENTICAL PERSON WHO DID EXECUTE AND SIGN THE FOREGOING COMPLAINT OF ERROR AND DID SIGN THE SAME INMY PRESENCE AND DID SWEAR (OR AFFIRM) ON HIS OATH THAT THE FACTS SET FORTH HEREIN ARE TRULY AND CORRECTLY STATED AND THAT HEDID SIGN AND EXECUTE THE SAME OF HIS OWN FREE WILL AND ACCORD.
DAY OFSUBSCRIBED AND SWORN TO BEFORE ME, THIS 1 20
NOTARY PUBLIC(SEAL)
MY COMMISSION EXPIRES COUNTY CLERK
TAX ROLL ERRORS SUBJECT TO CORRECTION UNDER 68 OKL.ST.ANN. § 287. 1I PERSONAL OR REAL PROPERTY IS ASSESSED TO ANY PERSON, ETC. NOT OWNING THE SAME;2. PROPERTY EXEMPT FROM TAXATION WAS ASSESSED;3. LAWFUL EXEMPTION DEDUCTIONS HAVE NOT BEEN TAKEN INTO ACCOUNT;4. THE SAME PROPERTY WAS ASSESSED MORE THAN ONCE THE SAME YEAR;S. PROPERTY, REAL OR PERSONAL, WAS ASSESSED THOUGH NOT TAXABLE FOR SUCH YEAR;6. IMPAIRMENTS BY FIRE, FLOOD, ETC. BEFORE MAY I ST WERE NOT DEDUCTED;7. LANDS OR LOTS HAVE BEEN ERRONEOUSLY DESCRIBED;8. VALUATIONS ENTERED ARE AT VARIANCE WITH VALUATIONS EQUALIZED;9. ASSESSOR OR EQUALIZATION BOARD DID NOT MAIL NOTICE OF VALUATION INCREASES;
I 0. PROPERTY HAD NO TAXABLE SITUS IN COUNTY, DID NOT EXIST OR WAS PLACED WRONG;I I PROPERTY WAS ACQUIRED AFTER JANUARY I ST BY THE COUNTY OR ANY CITY, TOWN, ETC.;1 2. TAX EXTENSIONS MISCALCULATED BY USE OF LEVIES PROPERTY NOT LIABLE FOR;1 3. CORRECTION OF THE NAME OF THE PERSON ASSESSED ON PERSONAL PROPERTY OR RECORD OWNER OF REAL ESTATE;1 4. ERRONEOUS TAX EXTENDED ON THE TAX ROLLS WITH CORRECT VALUATION;I S. ERROR IN TRANSCRIBING FROM COUNTY ASSESSOR'S SURVEY RECORD To ASSESSMENT ROLLS;1 6. COUNTY TREASURER RESTORES TAXES PREVIOUSLY STRICKEN WITHOUT COURT ORDER OR VOLUNTARY RESTORATION BY OWNER;1 7. PERSONAL TAX ENTERED WITHOUT ASSESSMENT BEING RENDERED OR NOTICE BEING GIVEN THE TAXPAYER.
ORDER OF CORRECTION BOARD AND CERTIFICATE OF ERROR
STATE OF OKLAHOMA, COUNTY OF , SS. BEFORE THE BOARD OF TAX ROLL CORRECTIONS
ON THE DAY OF 1 20 , THE WITHIN AND FOREGOING COMPLAINT OF ERROR OF TAXROLLS CAME ON FOR HEARING, THE COUNTY CLERK BEING PRESENT IN PERSON OR BY HIS AUTHORIZED DEPUTY AS REQUIRED BY LAW TO MAKEAND KEEP THE RECORD, THE COMPLAINANT OR His AGENT OR ATTORNEY HAVING BEEN DULY NOTIFIED OF THE DAY AND HOUR SET FOR SUCHHEARING AND SO AFFORDED FULL AND AMPLE OPPORTUNITY TO BE HEARD, THE COUNTY TREASURER AND COUNTY ASSESSOR WERE REQUIREDTO BE PRESENT WITH THEIR TAX BOOKS (OR THE DISCLOSURES THEREIN WERE SUPPLIED By AFFIDAVIT BY THEIR OWN HANDS AND UNDEROATH);
WHEREUPON THE RECORDS WERE DULY EXAMINED, ALL TESTIMONY WAS REDUCED TO WRITING AND MADE A PART OF THE RECORDS
PRESENT A PROPER CAUSE TO COME BEFORE THIS BOARD ANDHEREOF, AND THE BOARD FOUND THAT THIS COMPLAINT DOES
THAT THE REQUEST SHOULD BE ALLOWED, AND CREDIT, OR REFUND (IF PAID), IN THE AMOUNT OF $
BE GRANTED FOR THE FOLLOWING REASONS'
IF ALLOWED AND THE TAX IS UNPAID, THE SECRETARY IS HEREBY ORDERED TO NOTIFY THE COUNTY TREASURER TO CORRECT His TAXROLLS ACCORDING TO THE FINDING OF THIS BOARD:
IF ALLOWED AND THE TAX IS PAID, THE SECRETARY IS HEREBY ORDERED TO MAKE REFUND IN THE MANNER PROVIDED BY LAW.
By ORDER OF THE BOARD OF TAX ROLL CORRECTIONS AT , OKLAHOMA, THIS
DAY OF 1 20
CHAIRMANATTEST AND SEAL:CHAIRMAN OF BID. OF CO. COMM.
COUNTY CLERK
VICE-CHAIRMANBY DEPUTYCHAIRMAN, EQUALIZATION BD.
AND, IF THE TAX BE NOT PAID AS DISCLOSED HEREIN, TWOCOPIES HEREOF ARE HEREBY TRANSMITTED TO THE COUNTY MEMBER
COUNTY ASSESSORTREASURER AS ''CERTIFICATE OF ERROR'' OF THE VALUEAFORESAID, TO BE, BY HIM, ACCEPTED IN LIEU OF TAXSATISFACTION OF TAX CHARGES TO THE EXTENT HEREOF.
ENDORSEMENT
SS.STATE OF OKLAHOMA, COUNTY OF
I, THE UNDERSIGNED COUNTY TREASURER (OR LAWFUL DEPUTY), DO HEREBY CERTIFY THAT THE FOREGOING ORDER OF CORRECTIONHAS BEEN FULLY COMPLIED WITH AND ENTERED, EITHER
BY CERTIFICATE No TO THE TAX ROLL ENTRY ALREADY MADE WHERE THE1. BY ENTRY OF CREDIT FOR $ERROR WAS ONLY IN THE AMOUNT AND EXECUTION OF THE TAX, OR
2. BY CLOSING THE PREVIOUS ACCOUNT BY ENTRY OF CERTIFICATE NUMBER AND SHOWING OF, AND BY MAKING RE-ENTRY AT
LINE OF THE TAX ROLLS OF SAID YEAR, OF THE CORRECT AND PROPER ENTRIES IN, PAG E , BOOK NoACCORD WITH THE FOREGOING CERTIFICATE; AND BY THIS ENDORSEMENT, FOR THE ORIGINAL COPY GIVEN TO THE TAX DEBTOR, AND FOR THEDUPLICATE FOR RETURN TO THE COUNTY CLERK FOR CREDIT UPON HIS ACCOUNT WITH THE TAX CHARGES OF SAID YEAR.
,20DONE AT DAY OF, OKLAHOMA, THIS
COUNTY TREASURER
By DEPUTY
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S.A.&I. No. 365EMPLOYEE'S SALARY AND WAGE RECORD
HUSBANDS NAME IFNAMEEMPLOYEE IS MARRIED WOMAN
EXEMP- ADDRESSTIONSCLAIMEDOFFICE 0R
SOCIAL SECURITY ACCOUNT NO.DEPARTMENT
WITHHOLDING Damon FOR PAY EMPLOYEE SICK LEAVE (Days)GROSSGROSSSALARYSALARYDATE OF ANNUITY LESSOR WAGES NOT
CHARGEDWARRANT MEDICAREO.A.S.I.STATE TAX RETIREMENT INS.FED. TAX AMOUNTWT. NO. CHARGEDANNUITYAPPROVED- -
Totals2nd Qtr. -
REMARKSENTER HERE ACCUMULATED DAYS
SICK LEAVE END OF YEAR
TotalsIst Qtr.
I
Cum. TotalTo Date
Totals3rd Qtr.
Cum. TotalTo Date
Totals4th Qtr.
GRANDTOTALS
-S.A.&I. 382 (2000) ASSIGNMENT OF COUNTY CLAIM
For value received, I hereby sell, transfer and assign all my right title and interest in Claim No.against County, Oklahoma, in the amount of $(less any withholding required by law or voluntary agreement) toand authorize the County Clerk to issue warrant in payment of said purchase order to the above named assignee.
Witness my hand this day of
Signature of Claimant or his Agent
ATTESTATION AND CERTIFICATION OF COUNTY CLERK
By my signature and official seal I hereby attest the above assignment and the signature of the claimant (or hisauthorized agent) and I further state that the above described claim is on file in my office and awaiting action of thegoverning board. I further certify that if the above claim is allowed in full, the total withholding for all purposes willbe $ , and the net amount of the warrant will be $
ByCounty Clerk Deputy
APPROVAL OF OFFICER
I hereby state that the above described claim has been examined by me and approved for payment in theon theaggregate sum of $ Fund: Account No.'s
Head of DepartmentDate approved
NOTE
After completion and delivery to the assignee, this assignment should be returned to the County Clerk. The CountyClerk will attach this assignment to the claim which has been assigned and it will serve as his authority to issue thewarrant to the assignee.
20____
20
Title
OFFICER'S REQUEST FOR SUPPLEMENTAL APPROPRIATIONSCounty, Oklahoma
To The Honorable County Excise Board
the duly qualified and acting of the CountyI,and State aforesaid, do hereby certify that the following is a true and correct report of appropriations and
20and endingexpenditures of this office during the period beginning July 1, 20 .I further certify that the additional appropriations requested in column 8 are indispensable for the efficientoperation of my office for the remainder of this fiscal year, and I certify further that any balances of appro-priations in column 6 in excess of the needs to complete the first fiscal year, column 7, are available forcancellation.
Head of DepartmentBy
Title.S.A.&I. 388 (2000) Statement of appropriations, expenditures and balances as of
ADJUSTMENTS Expenditures Balance AdditionalNeeds ToOriginal To Date AppropriationsOn Date In CompleteAppropriationsP U R P 0 S E CancelledAdded Caption Caption Fiscal Year Requested
la Personal Services
Capital OutlayT 0 T A L S
i
Deputy20
1. 2. 3. 4. 5. 6. 7. 8.
,
23
Time helplb Partlc Travel Expense
& Operation Maintenance
-1
S.A. & I. NO. 396 (1997)
ELECTRONIC FEDERAL TAX PAYMENT SYSTEM ADVICE
DATE
EFTPS ACKNOWLEDGMENT NO.TO THE COUNTY TREASURER:
ON THIS DATE, I HAVE: NOTIFIED THE EFTPS AGENT TO ELECTRONICALLY WITHDRAW
FROM COUNTY FUNDS. THE FUNDS AND AMOUNTS TO BE$
DEBITED ARE AS FOLLOWS:
AMOUNTFUND
$
TOTAL $
I HEREBY ACKNOWLEDGE THE AMOUNTS WITHDRAWN ARE FOR FEDERAL TAX WITHHOLDINGPURPOSES AND DIRECT THE COUNTY TREASURER TO TAKE IMMEDIATE ACTION TO EFFECTUATE THETRANSACTION AND MAKE THE PROPER ENTRIES TO REFLECT THE SAME.
BYCOUNTY CLERK DEPUTY
FROM THE OFFICE OFCLIFTON H. SCOTT, P. A.
STATE AUDITOR AND INSPECTOR
RESOLUTION FOR DISPOSING OF EQUIPMENT
WHEREASCounty, Oklahoma, are required,and have power to make all orders respecting the property of the county, and to do and
perform such other duties and acts as may be required by law, andWHEREAS, the Board of County Commissioners of County,
Oklahoma, has under its management and control one item of equipment described as follows:
Date Acquired:Serial Number:Name and address of whom acquired:Cost price when acquired: $ Contract price if acquired under
Name and address of the person or firmlease-rental agreement: $to whom property transferredPrice received therefor: $
AND, upon proper and careful consideration, find that the above equipment is obsolete,and not economical to use in road repair, maintenance or construction , and that the use ofsaid equipment would require an expense that would not be justified for future use.
THEREFORE, after due consideration, and deeming it to be for the best interest ofCounty, the Board of County Commissioners hereby orders
the above described property , and that the title(sold, traded, or junked)
to the same be transferred by the Chairman of the Board of County Commissioners uponreceipt of the above amount by the County Treasurer.
Passed and approved in regular session this day of , 20BY THE BOARD OF COUNTY COMMISSIONERS,
County, Oklahoma.ATTEST:
ChairmanCounty Clerk
MemberBY
Deputy Member19 Okl.St.Ann. § 421, requires that the above resolution or record be madewithin 30 days after the disposition of the property and entered on theinventory record.
NOTE:
in compliance with 19 Okl.St.Ann.§ 339 and 19 Okl.St.Ann.§S.A.&I. 397 (2000)
421,the Board of County Commissioners of
,
NOTICE OF REFUSAL
The Office of County Clerk of County,Oklahoma, has on (date) refused to filea document designated
The document(title of document or brief description of document).constitutes a claim or lien on the following property:
In case of real property, description(Description of property.must be the legal description for the property.) A copy of therefused document must be attached to this Notice of Refusal or theclerk cannot accept it for filing.
Signed:Aggrieved party or attorneyfor aggrieved party
Address:
S.A.&I. 403 (2000)
State of Oklahoma, ) SS. ___________County. )
Before me, ___________________, in and for said county and state,
on this _____ day of ____________, 20____, personally appeared
_________________ and ___________________ to me known to be the
identical person__ who executed the within and foregoing instrument
and acknowledged to me that ____ executed the same as ____free and
voluntary act and deed for the uses and purposes therein set forth.
Signed: ________________________ County Clerk
_________________ County, Oklahoma
''When a notice of tax lien is received, the filing officer shall retain It and shall forthwith file it alphabetically and enter it in an alphabetical federal tax lien Index showingthe name and address of the person named in-the notice, the District Director's serial number of the notice the date and time of receipt, and the amount with the interest, penalties and costs.''
.
3405
Alphabetic SectionPage Number
FEDERAL TAX LIEN RECORDS. A. & I. 405 (2000)
Received
68 Okl.St.Ann. §
Mo. Day Yr. Hr. Mo. Da. Yr.
ReleaseDate of Reception File No. Serial No.of Notice
Tax Debtor Named in Notice
Tax Debtor's Address
Total Amt. of Lien
Notation Pertinent to Release
S.A.& I. 413 (2000)
COUNTY CLERK'S CERTIFICATE OF RETURNS FILEDFOR ISSUANCE OF TAX DEED
To the County Treasurer:
This is to certify that , the owner of
issued on the day oftax sale certificate(s) numbered
covering
has complied with the provisions of 68 Okl.St.Ann. § 3118, by filing in the office of the County Clerk notice prop-erly served or published as required to obtain tax deed as follows:
Fee $Service by Sheriff, dated
Service by publication, (If required)
Fee $Date of first publication
The statute requires the fees for service of notice as above shown to be added to the amount necessary to redeem the abovedescribed land, lot or tract from sale, and you are to make notation of same on your sale record.
day ofGiven under my hand and seal this
(SEAL)County Clerk.
20
20
COUNTY ASSESSOR'S BUDGETFOR Visual Inspection Program
S.A.& I. 415(2000)
To the County Excise Board
Countyofin order to comply with the mandatory requirements of statute pertaining tothe Visual Inspection Program, you are requested to consider and approve thefollowing:
VISUAL INSPECTION BUDGETAmount Approvedby Excise BoardAmount Requested
Assistants or Deputies $
Appraisers
TravelMaintenance Supplies
Total Budget $20day ofRespectfully submitted this
County Assessor* See pro-ration of total budget per benefiting jurisdiction as shown on
the reverse side.to be prorated and included in theApproved in total amount of $
as provided by 68 Okl.St.Ann.§ 2822.several budgets for 20day of 20, Oklahoma, theDated at
Chairman
AttestMember
MemberCounty Clerk & Secretary
- ......
S.A.& I. 415 page 2COUNTY ASSESSOR'S BUDGET FOR THE VISUAL INSPECTION PROGRAM CONTINUED
20VISUAL INSPECTION CHARGES FOR FY 20Based on 20_____-20 Ad Valorem Tax Collections
for the recipient governmental units,schools, and other units listed below.
VisualDecimal InspectionCountyDescription 20___ Tax20 Fraction Charge
20FY 20to totalCollections - ---SCHOOLS
Independent School Districts1.2.3.4.5.6.7.8.
Dependent School Districts1.2.3.
Vo-Tech School Districts1.2.
Joint School Districts1.2.3.4.5.
TOTAL ALL SCHOOL DISTRICTS
CITIES AND TOWNS1.2.3.
TOTAL ALL CITIES AND TOWNS
CountyCounty Health UnitCounty Library Unit
TOTAL ALL COUNTY UNITS
GRAND TOTAL $ $1.0000000
S.A.&I. 425 (2000)AFFIDAVIT FOR FILING WITH COMPETITIVE BID
STATE OF OKLAHOMA )) SS
COUNTY OF )
on oath, of lawful age, being first duly sworn,says, that (s)he is the agent authorized by the bidder to submit the attached bid.Affiant further states that the bidder has not been a party to any collusion among bid-ders in restraint of freedom of competition by agreement to bid at a fixed price or torefrain from bidding; or with any county official or employee as to quantity, quality
or any other terms of said prospective contract;or price in the prospective contract,or in any discussions between bidders and any county official concerning exchange ofmoney or other thing of value for special consideration in the letting of a contract.
day ofSubscribed and sworn to before me this
Notary Public (or Clerk or Judge)
Note:Each competitive bid submitted to a county, school district or municipality must beaccompanied with the above Affidavit as required by 61 Okl.St.Ann.
20
My commission expires:_______________
§ 138
Signature
BIDDER:
.
S.A.&I. 428 (2000)
RESOLUTION APPOINTING PURCHASING OFFICERSFOR BOARD OR COMMISSION
BE IT RESOLVED, in accordance with the provisions of 62 Okl.St.Ann.,§ 310.lc the following employees ofare hereby designated as purchasing officers with authority to initiate purchasesagainst the indicated appropriation accounts.
Maximum AmountApprop. Authority of Bond
Employee Position Acct. (Optional)Per Purchase
The Purchasing officers designated above shall have the authority to make in-dividual purchases from the indicated appropriation accounts in an amount not to exceedthat authorized above and shall comply with all statutory provisions of the State ofOklahoma, and the rules and regulations of the Board of County Commissioners. Theauthority granted herein shall be for the term of and shall expire onJune 30, 20 unless revoked or amended by action of the Board or Commission priorto that date.
day ofPASSED AND APPROVED this
ChairmanATTEST:County, Oklahoma
Clerk or Secretary
Board or Commission
$$
20
20 -
S.A.&I. 429 (2000)
RESOLUTION APPOINTING PURCHASING OFFICERS
BE IT RESOLVED, in accordance with the provisions Of 62 Okl.St.Ann. the following county employees are designated as purchasing
with authority to make purchases against the indicated county appropriations and shall be bonded for the amount specified herein:
MaximumAuthority AmountApprop.
Employee Position Account # Per Purchase of Bond
The purchasing officers designated above shall have the authority tomake individual purchases from the indicated appropriation accounts in an amountnot to exceed that authorized above and shall comply with all statutory pro-visions of the State of Oklahoma, The authority granted herein shall be for the
unless revoked byterm of 20 , 20 , and shall expire on June 30, 20action of the Board of County Commissioners prior to that date.
day ofPASSED AND APPROVED this
ChairmanATTEST:
Board of County Commissioners ofCounty, Oklahoma
County Clerk(SEAL)
Note.The County Commissioners may add any rules or regulations governing the activitiesof each purchasing officer which they deem to be in the best interest of the county.
officers
20
310.1c,§
$ $
S.A.&I. 430 (2000)RESOLUTION DETERMINING MAXIMUMMONTHLY HIGHWAY EXPENDITURES
AppropriationAccount Amount
The authority granted herein shall be for the calendar month of
and expire on the last day of said month.
PASSED AND APPROVED this day of
ChairmanATTEST:
Board of County Commissioners ofCounty, Oklahoma
County Clerk(SEAL)
Note:The amounts listed above should never exceed the unencumbered balance of theappropriation account.
20,
$
BE IT RESOLVED, in accordance with the provisions of
62 Okl.St.Ann. § 310.1c, purchasing officers having authority to
expend county highway funds may encumber amounts not to exceed
that indicated below:
20
REQUISITION - PURCHASE ORDER - CLAIMS. A. & I. 1116 (2000)PurchaseRequisition NoOrder NoCounty, OklahomaBlanket P.O.
I approve the Processing of this Purchase request and the encumbering onDate AssignedDate Req. Rec.Requisitioning Dept. the designated account to & maximum of
Date Material NeededProject No.
Date Requisitioning County Official
SUGGESTED VENDORS
Fiscal Year 20___ - 20DATE APPROPRIATION ACCOUNT
I hereby approve the issuance and encumbrance of this purchase order.
Purchasing AgentI hereby certify that the amount of this encumbrance has been entered against the designated
appropriation accounts and that this encumbrance is within the authorized available balance of saidappropriation.
DATED THIS DAY OF
County Clerk / Deputyof County.
Amt To BeUnitDescriptionUnitQuantity Adjustment ApprovedPrice Encumbered Amount
CHARGE & APPROVAL BY GOVERNING BOARDINVOICE TO:This claim is approved for payment in the amount indicatedabove. (Signed by at least two members.) District Attomeyis approving officer for expenditures for that office.
County Clerk
19 Okl.StAnn. § 326.Okla.
DateI hereby certify that the invoice, receiving report and delivery documentation have beencompared to this purchase order, and any discrepancies have been reconciled as noted above.This purchase order is therefore approved for consideration for payment by the governing board.
AccountDate 20No.
County Clerk / Deputy
Date Returned For Filing For Consideration By The Governing Board PAYMENT RECORD20 WARRANT NUMBER
AMOUNTSCOMPLETE WHEN USED WITH BLANKET PURCHASE ORDER WarrantPursuant to 62 Okl.St.Ann. § 310.6 the Encumbering Officer has theI also certify that the maximum amount of the blanket purchase order has not been exceeded. No.approving authority for payment of requisitions with attached invoices against Therefore. I herebyGoverning Board approved blanket purchase orders.Date
County Clerk / Deputy
DateDataRequesting County Officer County Clerk / Encumbering Officer
Copy l - Requisition Form to Purchase Agent Copy 3 - Purchasing Agent Copy 6 - Requesting OfficerCopy 2 - County Clerk Copy 4 - Co. Road & Bridge Inventory Officer /
Commissioner's Office
Account
ALL PRICES ARE FOB DESTINATION UNLESS OTHERWISE NOTED
20_________
19 Okl.St.Ann. § 1505 requires the vendor to furnish an itemized invoice which states the vendor's name and address, a clear description of each item purchased, it's unit price, the number or volume of each item, it's total price, the total of the purchase, and the date of the purchase.
Total
Member
Member
Chairman
authorize payment of the attached approved invoice.
Issue To:
Ship To:
Total
TRAVEL CLAIMS.A. & 1. 11 17 (2000)(Note: To be attached and processed on Purchase Order for payment)
Statute Reference: 19 OkI.St.Ann. § 162-165 and 19 OkI.St.Ann. § 166
Nature of BusinessNameTitleCounty
ODOMETER READING-
Total Miles;ALL EXPENSE RECEIPTS AREREQUIRED TO BE ATTACHEDBEFORE REIMBURSEMENTCAN BE MADE.
Total TotalTotal $
19 OkI.St.Ann. 163 Total Amount Claimed
the undersigned, upon Account No.1,oath , do depose and say I have full knowledge of the aboveand foregoing account, that said account is just, correct, dueand according to law; and Is now due and wholly unpaid,and I am duly authorized to make this affidavit.
Date ,20The approving officer further certifies that he hastaken and filed the oath required by 51 OkI.St.Ann.§ 36.1-36.6, and said approving officer alsocertifies that the officer or employee whose nameappears on this travel claim has taken and filedsaid oath as required by 51 OkI.St.Ann. § 36.1.
Claimant
Subscribed and sworn to before me I
20-
Approving OfficerNotary Public/County Clerk
20My commission expires: Title--
Date Ending Beginning Totalmiles
LodgingAmount
Other ExpenseAmount
per mile@
County Officer's Annual Report
Please Read Carefully
This form is designed for use by all INDEPENDENT OFFICES AND AGENCIES including the following:
''A'' DISTRICT ATTORNEY
''B'' COUNTY SHERIFF
''C'' COUNTY TREASURER
''D'' COUNTY COMMISSIONERS
"F" COUNTY CLERK
''H'' COUNTY ASSESSOR
''I'' COURT CLERK
"J'' DISTRICT COURT
''SL'' ELECTION BOARD
''U'' COUNTY EXCISE-EQUALIZATION BOARD
S.A. & I. No. 11 61 (2000)
"SO" VISUAL INSPECTION
Office ofDepartment
County, OklahomaANNUAL REPORT FOR THE FISCAL YEAR ENDING JUNE 30, 20
AND ESTIMATE OF EARNINGS OF THE ENSUING FISCAL YEAR
To The Honorable Board of County Commissionersand County Excise Board:
, the duly qualified and acting1,of the County and State aforesaid, do hereby certify that the following is a true and correct report of the earn-ings of my office during the fiscal year just closed with a statement of estimated earnings, not exceeding statutorylimitations, for the ensuing fiscal year.
REPORT AND ESTIMATE OF EARNINGSCOLLECTIONS OF 90% NORMALLYCLASS OF ITEMSTHE YEAR JUST RECURRENT SOURCES
CLOSED(List only fees to County General Fund) OF PRECEDING YEAR
THE DUTY OF TAXING OFFICIALSSupreme Court Case 22,626. Opinion Filed April 26, 1932.
The Duty of Taxing Officials to make Appropriations is plain and definite, and the refusal to perform such dutyis sufficient to authorize the issuance of a writ of mandamus.
''It is not only the duty of taxing officials to make appropriations for the Performance of constitutional govern-mental functions, but it is the duty of the officers charged with the performance of those duties to see that thoseappropriations are made, and such officers may not sit idly by and see the income and revenue of the county appro-priated for other purposes and then recover compensation for the performance of their duties.''
S.A.&I. 1161 (2000)
Total Earnings
Office ofCounty, Oklahoma
ANNUAL REPORT FOR THE FISCAL YEAR ENDING JUNE 30, 20AND ESTIMATE OF NEEDS FOR THE ENSUING FISCAL YEAR
, the duly qualified and actingof the County and State aforesaid, do hereby certify that the following is a true and correct report of expendituresof this office during the fiscal year just closed with an estimate of my actual needs for the ensuing fiscal year.
REPORT OF PRIOR EXPENDITURES AND ESTIMATE OF NEEDSNet Amount DeterminedCLASSIFICATION Warrants EstimateUnencumberedAppropriations ReservesItems of Expense IssuedBy Excise Board of NeedsBy Officer
la Personal Serviceslb Part-time Help
SET OUT BELOW ANY DETAIL DEEMED ESSENTIAL TO EXPLAIN ESTIMATE FOR ENSUING YEARPersonal Services:
Statutory Annual Salary of Principal Officer $Annual Salary of First Deputy $
Annual Salary of Second Deputies at Per Annum$ $Annual Salary of Third Deputies at Per Annum$ $
Per AnnumAnnual Salary of Fourth Deputies at $ $Annual Salary of Per AnnumDeputies at $ $
Total of Principal Officer and Deputies SalariesWages and/or Compensation of Part-time Help $Travel Expenses as Authorized and/or Defined by Law $
TOTAL FOR ALL PERSONAL SERVICES $
Maintenance and Operation:Postage, Telephone and Telegraph $Books, Printed Forms, Ledgers and other Supplies $Repair and Upkeep of Office Furniture, Machines and Equipment $
TOTAL FOR MAINTENANCE AND OPERATION $
Capital Outlay:Furniture, Machines and Equipment to be replaced $
$Additional Furniture, Machines and Equipment Needed
TOTAL FOR CAPITAL OUTLAY $
Respectfully Submitted,Official Title
TO THE HONORABLE BOARD OF COUNTY COMMISSIONERSand COUNTY EXCISE BOARD:
I,
$
1c Travel Expense2 Maintenance and Operation3 Capital Outlay
TOTAL
OFFICER'S ANNUAL REPORT OF EARNINGS, EXPENDITURES,ESTIMATED INCOME AND NEEDS
County, State of Oklahoma:
maintenance of the office of0
County of ,Oklahoma, covering the fiscal year ending June 30, 209
including an itemized statement of the estimated income and approximate needs of said office for the en-suing fiscal year
Dated at , Oklahoma, this day of
Name of Official
Official Title
GENTLEMEN; in pursuance of requirements of 68 Okl.St.Ann. § 3004, and other statutes,there is set forth on the reverse side hereof an itemized statement of the accrued earnings and the cost of
I further certify that the several items of probable needs are indispensable for the proper administrationof the affairs of said office for the ensuing fiscal year. You will please include the same in the publishedCounty Estimate and Budget filed with the County Excise Board as provided by 68 Okl.St.Ann. § 3002.
20
To: The Honorable Board of County Commissioner and County Excise Board
AN
NU
AL
REP
OR
T
of th
e
of
Earn
ings
and
Exp
endi
ture
sfo
r
FISC
AL
YEA
R E
ND
ING
JUN
E 30
, 20
____
__an
d
Estim
ated
Inco
me
and
Nee
ds
FOR
EN
SUIN
G F
ISC
AL
YEA
R
File
d th
is _
___
day
of _
____
____
__ 2
0___
_
____
____
____
____
____
___
Cou
nty
Cle
rk
By
____
____
____
____
____
____
_ D
eput
y
County Officer's Annual ReportPlease Read Carefully
This form is designed for use by all DEPENDENT OFFICES and CONTRACTUAL AGENCIES, including the fol--lowing:
''E'' OSU Extension Center
"W" Welfare Agencies
"Q" Charity
"B" General Government
''CD'' Civil Defense
''SA" Highway Budget Account
''SC'' County Audit Budget Account
''SE'' County Cemetery Budget Account
"SF" Free Pair Budget Account
''SH'' Library Budget
"SL" T. B. and Public Health Budget
''SJ'' County Hospital Budget Account
"SM'' Child Guidance Clinic
''SN'' Fire Fighting Service
and other dependent and OPTIONAL DEPARTMENTS AND CONTRACTUAL AGENCIES which are amenable to theBoard of County Commissioners.
Items appearing on the Budget but not on this form should he written in exactly as they are on the Budget.
S.A. & I. No.1162 (2000)
Department Office of
County, OklahomaANNUAL REPORT FOR THE FISCAL YEAR ENDING JUNE 30, 20
AND ESTIMATE OF EARNINGS OF THE ENSUING FISCAL YEAR
To The Honorable Board of County Commissionersand County Excise Board:
, the duly qualified and actingof the County and State aforesaid, do hereby certify that the following is a true and correct report of the earnings of my office duringthe fiscal year just closed with a statement of estimated earnings, not exceeding statutory limitations, for the ensuing fiscal year.
REPORT AND ESTIMATE OF EARNINGS
CLASS OF ITEMS COLLECTIONS OF 90% NORMALLYTHE YEAR JUST RECURRENT SOURCES
( List only fees to County General Fund) OF PRECEDING YEARCLOSED
THE DUTY OF TAXING OFFICIALS
Supreme Court Case 22.626. Opinion Filed April 26, 1932.The Duty of Taxing Officials to make Appropriations is plain and definite, and the refusal to perform such duty is sufficient to
authorize the issuance of a writ of mandamus.''It is not only the duty of taxing officials to make appropriations for the performance of constitutional governmental functions,
but it is the duty of the officers charged with the performance of those duties in see that those appropriations are made, and such offi-cers may not sit idly by and see the income and revenue of the county appropriated for other purposes and then recover compensationfor the performance of their duties.''
S.A. & I. 1162 (2000)
I,
Total Earnings
-
Office of
County, OklahomaANNUAL REPORT FOR THE FISCAL YEAR ENDING JUNE 30, 20
AND ESTIMATE OF NEEDS FOR THE ENSUING FISCAL YEAR
To The Honorable Board of County Commissionersand County Excise Board:
the duly qualified and actingof the County and State aforesaid, do hereby certify that the following is a true and correct report of expenditures of this office duringthe fiscal year just closed with an estimate of my actual needs for the ensuing fiscal year.
REPORT OF PRIOR EXPENDITURES AND ESTIMATE OF NEEDS
EstimateDeterminedNet Amount Approved ByWarrantsCLASSIFICATION byunencumberedAppropriations Board of CountyReservesOfficerIssued By OfficerItems of Expense COMMISSIONERSBy Excise Board
SET OUT BELOW ANY DETAILS DEEMED ESSENTIAL TO EXPLAIN ESTIMATE FOR ENSUING YEARPersonal Services
Maintenance and Operation
Capital Outlay
Respectfully Submitted,
Official Title
I, ,
1a Personal Services1b Part-time Help
1c Travel Expense
2 Maintenance & Operation
3 Capital Outlay
Total
County ofOffice of
Warrant
State of Oklahoma
No
Dept. ofTo TheCounty Treasurer
Total Amount Allowed
Payment No
ORDER
LNet Amount of Warrant
Warrant Registered
available to Pay same
BY
County of
Dept. of
Purpose
Payment No.Total Amount Allowed $
To TheCounty Treasurer
DOLLARS$Net Amount of Warrant
Warrant Registered
PRIN. $_____________ INT. $_____________
TOTAL $_____________
20_____
SeriesP.O. No._________Acct. No.__________
Purpose
S. A. & I. 1291 b (2000)
County Clerk
Attest: I truly certify that the purpose stated is, insummary, as disclosed on the face of the claim andthat the amount thereof is within the sum availablethereof. (seal)
County ClerkDeputy
Out of the General FundWith interest from registration at ______% to legalmaturity. BY ORDER OF BOARD OF COUNTY COMMISSIONERS Chairman
Dollars
State TaxFed TaxSoc. Sec.MedicareRetirementInsurance
Funds are_______
Deputy
S. A. & I. 1291 (2000)GENERAL FUND
P.O. No. ________ ACCT. No.________
State taxFed. taxSoc. Sec.MedicareRetirementInsurance
20___Funds are_____available to pay same.
State of Oklahoma
Series
PRIN. $_________INT. $_________TOTAL $_________
County Treasurer
Deputy
County Treasurer
Office ofCounty Clerk
Pay ToThe Order Of:
Pay To
Attest: I, truly certify that the purpose stated is, in summary, as disclosed on the face of the claim and that the amount thereof is within the sum available thereof. (seal)
County Clerk
Deputy
Out of the General Fund
with interest from registration at _____% to legal maturity. BY ORDER OF BOARD OF COUNTY COMMISSIONERS
Chairman
WarrantNo.
Okla. 20
GENERAL FUND
The Order Of:
Okla.
$
$
20____
S. A. & I. 1292 (2000)BUILDING FUND PRIN.Office of
INT. $County Clerk State of Oklahoma TOTAL $P.O. No. ACCT. No.Dept. of
Series
Total Amount AllowedPayment No.State tax
To The
Fed. tax WarrantNo.Soc. Sec.
MedicarePay To
RetirementInsurance
$Net Amount of WarrantFundAttest: I, truly certify that the purpose stated is, in
summary, as disclosed on the face of the claim andOut of the
20Warrant Registeredthat the amount thereof is within the sum available % to legalwith interest from registration at
Funds are available to pay same. (seal)thereof. maturity.BY ORDER OFCounty ClerkCounty Treasurer BOARD OF COUNTY COMMISSIONERS
DeputyDeputy Chairman
County of $
Okla.
County Treasurer
Dollars
BUILDING
Purpose 20
The Order Of:
$ __________
S.A.& I. 1293(2000)PRIN. $Office of County ofCASH FUND INT. $County Clerk State of Oklahoma TOTAL $ACCT. No.P.O. No.
Dept. ofSeries
Purpose Okla. 20To TheTotal Amount Allowed $County Treasurer Payment No.State tax
Fed. tax WarrantPay ToSoc. Sec. No.
Medicare The Order Of,RetirementInsurance Dollars
$Net Amount of WarrantAttest: I, truly certify that the purpose stated is, in20Warrant registered Out of the CASH FUNDsummary, as disclosed on the face of the claim andthat the amount thereof is within the sum availableFunds are available to pay same.
(seal) BY ORDER OFthereof.BOARD OF COUNTY COMMISSIONERSCounty ClerkCounty Treasurer
DeputyDeputy Chairman
S.A.& I. 1294(2000)PRIN. $Office of County ofCASH FUND INT. $County Clerk State of Oklahoma TOTAL $P.O. No. ACCT. No.
SeriesPurpose Okla. 20Total Amount Allowed
Payment NoTo The
State taxFed. tax Warrant
County Treasurer
No.Soc. Sec.Medicare
Pay To
RetirementInsurance DollarsNet Amount of Warrant $
Attest: I, truly certify that the purpose stated is, in20Warrant registered CASH FUNDOut of thesummary, as disclosed on the face of the claim andthat the amount thereof is within the sum availableFunds are available to pay same. BY ORDER OF(seal)thereof.
BOARD OF COUNTY COMMISSIONERSCounty ClerkCounty Treasurer
DeputyDeputy Chairman
Dept. of
HIGHWAY
HIGHWAY
$
The Order of:
PRIN. $Office of County of INT. $County Clerk State of Oklahoma TOTALP.O. No. ACCT. No.Dept. of
SeriesPurpose Okla.$Total Amount Allowed
Payment No.State taxTo The
WarrantFed. taxCounty Treasurer
No.Soc. Sec.Medicare
Pay To
RetirementInsurance Dollars
$Net Amount of Warrant Attest: I, truly certify that the purpose stated is, insummary, as disclosed on the face of the claim and
FundOut of the
% to legalthat the amount thereof is within the sum available with interest from registration atFunds are available to pay same. (seal)thereof. maturity.BY ORDER OFCounty ClerkCounty Treasurer BOARD OF COUNTY COMMISSIONERS
DeputyDeputy Chairman
S. A. & I. 1299 (2000)
HEALTH DEPARTMENT FUND
Warrant registered 20HEALTH DEPARTMENT
20
The Order Of:
$
FOR FISCAL YEAR ENDING JUNE 30, 20___
ACTION BY GOVERNING BOARDAMOUNT OF AMOUNT WARRANTAPPROP.PURCHASE OFNAME OF VENDOR OR CLAIMANT
AMOUNT AMOUNTACCT.ADJUSTMENT DISALLOWED APPROVED
PURCHASE ORDER CALENDAR
Purchase Order Number Mo. Day Number
S. A. & I. 1821 (2000)
Mo. Day ORDER
DATERETURNED
Mo. Day
DATE
OFFICE OF THE COUNTY CLERK
WARRANTCOUNTY, OKLAHOMA
Payment No
TO THE COUNTY TREASURER:
Pay to the Order of
Treasurer of City or Town of $
Dollars
Collections for the Month of
Deputy
Remittance Statement for the Month of
WARRANTCity or Town of
City or Town Treasurer Detach Remittance Statement and File for Ledger Posting
20____
Remittance Warrants for Cities & TownsS. A. & I. 2101 (2000)
________________________ , Oklahoma ___________
_______________________ , 20____
County Clerk
Bank No.
20____
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
20
20
GENERAL FUND AMOUNT BUILDING FUND AMOUNT
Ad valorem Tax: $ Ad valorem Tax: $
Year of 20 Year of 20___
Year of 20 Year of 20___
Year of 20 Year of 20
Year of Year of 19
Year of 20
19Year of
Total Building Fund
SINKING FUND AMOUNT
Ad valorem Tax:LabelYear of
Year of 20LabelAlcoholic Beverage Tax Year of 2 20
Year of 19
Total General Fund Total Sinking Fund
STREET AND ALLEY FUND AMOUNT MISCELLANEOUS AMOUNT
.Motor Vehicle Collections
Total Street and Alley Fund $ Total Miscellaneous $
County WARRANT NORemittance Warrants for SchoolsOFFICE OF COUNTY CLERK
Payment No, Okla.
20TO THE COUNTY TREASURER:
Pay to the Order of
$Treasurer of School District No.
Dollars
Gen.Collections for the Month ofCounty Clerk4 Mill
Bldg.DeputySinking
Remittance Statement for the Month of
Warrant No.School District No.
Total Building FundReceptions JT SD
BANK NO.
20____
S.A.&I. 2102 (2000)
GENERAL FUND AMOUNT I BUILDING FUND AMOUNTAd valorem Tax: $ Ad valorem Tax $Year of 20 Year of 20Year of 20 Year of 204 Mill Levy Year of __
Year of 20 Year of __Year of 20Year of __ Double Homestead
Year of __
State Apportionment SINKING FUND AMOUNTMortgage Tax Ad valorem Tax:Motor Veh.Coll.for Schools Year of 20R.E.A. Tax Year of 20Mobile Home License Year of __Receptions JT SD Year of __Interest EarnedDouble Homestead Double Homestead
Total General Fund $ Total Sinking Fund $
Office of CountyCounty Clerk
Oklahoma
To The County Treasurer:
Pay to the Order Of
Dollars
Purpose:
County ClerkCollections for the Month of
Deputy
WARRANT NO.
payment no.
$______________
20____
MISCELLANEOUS ITEMS
S. A. & I. 2103 (2000)
$
20
SECTION ACOUNTY CLERK'S TAX SALE RECORD
COUNTY TREASURER'S RETURNS OF SALES OF REAL ESTATE FOR DELINQUENT TAXTOGETHER WITH RECORD OF COUNTY REDEMPTION
ENTRY OF RETURN OF SALE TO THE COUNTY S. A.& I. 2191 (1985)
CERTIFICATE OF REDEMPTION OR ASSIGNMENTLOCATION OF PROPERTY SOLD CLASS AND YEARSAND AMOUNT OF TAX SOLD FOR
TRANSFER TO SEC. BDATE REDEEMEDCOUNTY ON REFERENCE TOCERTIFICATE RECORDOR DEEMEDBY WHOM RETOTAL AMOUNT
SUBDIVISION OFASSIGNEDKIND AND YEARSSALE SCHOOL SEC. No.RETURNS RNG.
CITY-TOWN ORSOLD FORCLASS OF TAX ASSESSED ANDDISTRICT OR TWP. OF CERTIFIDESCRIPTION OR TO WHOM ASSIGNED TAX, INT. ASSIGNMENT
INCLUDED DELINQUENTPAGE No. LOT ACRESNo. BLK. CATEAND COSTS CERTIFICATE RECORDNo.
Year PAGEMo. Day
TAX SALE RECORDTO COUNTY FOR THE ORIGINAL TAX SALE OF OCTOBER
ASSIGNMENT, OR COUNTY TREASURER'S RETURN OF RESALE THEREOF.ENTRY CLOSING THIS RECORD-REDEMPTION, RESALE OR TRANSFER TO CERTIFICATE RECORD (SEC. B.)
-
ENTRY OF COUNTY TREASURER'S RETURN OF RESALE OF UNREDEEMED PROPERTYFROM SALE TO THE: COUNTY EXCESS PROCEEDS TO OWNERS
TAXDATEKIND AND AMOUNTTOTAL AMOUNTADDITIONAL
RESOLDTOTAL ACCRUED NAME OF OWNERCLASS OF TO WHOM RESOLDRECEIPT SOLD FORREDEEMED EXCESS PROCEEDSEXCESSYEARS OF
TO DATE OF RESALE AS PER LAST TAX ROLLADDITIONAL (COUNTY OR (NOT INCLUDING PAIDRESALEOR ASSIGNEDASSESSMENTS VOUCHERNO. (AS PUBLISHED) (AS PUBLISHED)TAX NAME OF INDIVIDUAL)FOR PROCEEDS TOINCLUDED RESALE COST No.
ACCRUED AND FEES)
Size 17 x 28 across folio page-
MO. DAY YEAR
COUNTY CLERK'S TAX SALEENTERED FROM COUNTY TREASURER'S RETURN OF SALE OF REAL ESTATE FOR DELINQUENT TAXES TO
S.A.&I. 2192 (1985)
COUNTY CLERK'S ENTRY OF INDIVIDUAL REDEMPTIONCOUNTY CLERK'S ENTRY OF ISSUANCE OF INDIVIDUAL TAX SALE CERTIFICATE
AmountYears ofKind &, Class Redeemed forIndividualDate of Delinquentof TaxYears ofKind & Class
ExcludingAssignment Date of ORIGINAL CERTIFICATE OR
Amount ofAssessmentsRedemption Included inRedemption
of Tax AssessmentTax Sale
REDEEMED BYTax Sale
RedemptionCertificate or
shown onInvolved in Certificate
Redemption
Certificate
CertificateIncluded inCertificate
FeesAssignment
Redemption
ASSIGNMENT CERTIFICATE
Certificate
No.Delinquent or AssignmentCertificate orNo.
No.Tax Lien(issued at
Assignment(Sale of ISSUED TO Orig. Sale) County Lien)
ENTRY OF RETURN OF SALE TO INDIVIDUALS ONLY (County on S.A.&I. No. 2191) AND SUBSEQUENT ASSIGNMENT OF COUNTY SALE, AND OF REDEMPTIONS.
Mo. Day Year Mo. Day Year
ICATE RECORDCERTIF
NT ASSIGNMENT OF COUNTY SALESINDIVIDUALS, FOR ORIGINAL TAX SALE OF OCTOBER_________ ___ AND SUBSEQUEENTRY CLOSING THIS RECORD-CLAIM OF REDEMPTION MONEY, CANCELLATION OF CERTIFICATE, OR ISSUANCE OF DEED.
COUNTY CLERK'S RECORD OF APPLICATSURRENDER OF ORIGINAL OR ASSIGNMREDEMPTION MONEY DISBURSED
EPOSITDate Service
COUNTY CLERK'S USE OF COST D Date of DeedDatePurpose Returns Complete DEED ISSUED TODate Paid To
(For Issue of DeedBY WHOM SURRENDERED
OR BOND MADE BY WHOM
SurrenderedByCertificate
Excessor Bond Approved DeedRedemption Money Printer'sSheriff'sDay
VoucherOwner TO WHOM PAID
Mo. Yearor Cancellation) FeesChargesDay FeesNo.
Mo. Year
across folio page17 x 28Size -
ENT TAX SALE CERTIFICATE ION FOR AND ISSUANCE OF CERTIFICATE TAX DEED(or Bond Made and Approved in Substitute)
Depositfor
ServiceCosts Returned Mo. Day Year Mo. Day Year
APPROPRIATION LEDGER AND ENCUMBRANCERECORD FOR SALARIES AND WAGES
AMOUNT OF APPROPRIATION
SUPPLEMENT FROMAPPROPRIATED TOAPPROPRIATED TO
DateDate AmountAmountDate AmountTITLENAME OF OFFICER
APPROPRIATION FOR(Salaries or Wages)
FOR FISCAL YEAR ENDING JUNE 30, FOR DATE OF CLAIM SEE CLAIM CALENDARACCOUNT NUMBER NET APPROPRIATION FOR FISCAL YEAR
S. A. & I. 2621 (2000)BALANCE CUMULATED RESERVESWARRANT PAYMENTS BALANCE
TO WHOM ISSUED Date TotalStateFederal Bonds Retirement InsuranceO.A.S.I.Number WithholdingsTax Tax20
Brought Forward
$
TotalUnencumbeed Balance
CountyObligation O.A.S.I.
Unexpended Balance
Cumulative Total of Warrants To Date
Amount of EachWarrant
ByWarrantNumber
Salary or Wages Allowed
Claim
Form to be lined , ruled and numbered.
ORIGINAL
APPROPRIATION LEDGER AND ENCUMBRANCE RECORD AMOUNT OF APPROPRIATIONOBLIGATIONS OTHER THAN SALARIES OR WAGES SUPPLEMENT FROMAPPROPRIATED TOAPPROPRIATED TO
TITLE AmountAmountDateAmount(Name of Officer)
APPROPRIATION FOR(PURPOSE OTHER THAN SALARIES OR WAGES)
FOR FISCAL YEAR ENDING JUNE 30,ACCOUNT NUMBER NET APPROPRIATION FOR FISCAL YEAR $
BALANCESENCUMBRANCES PAYMENTS BY WARRANT
DateTO WHOM ISSUED Cumulative CumulativeDateOrders On ByTotal ofAdjustmentsEncumbrance UnexpendedTotal of Unliquidated UnencumberedClaim Warrant of EachEncumbrancesNumber BalanceWarrants(See Note) Encumbrances Balance20 Number Number Contracts WarrantTo Date To Date
Brought From Page
Date Date
NOTE: When payment exceeds original encumbrance for sufficient reason such as postage or other prepaid carrying charges, enter excess in black ink in adjustment column to indicate addition, if less, enter decrease in adjustment column in red to indicate subtraction.
20 ____
S. A. & I. 2622 (2000)
Amountor
Form to lined, ruled and numbered.
ORIGINAL
Office of County Voucher No.County Clerk
20Oklahoma -
Coun
ty C
lerk
's Ca
sh V
ouch
er
Payment No.To The County Treasurer:
Gene
ral F
orm
$Pay to the Order of
Purpose:
Claim No. County Clerk
DeputyFund or Account:
CountyOffice of Voucher No.County Clerk
20Oklahoma
Coun
ty Ct
erk's
Cas
h Vo
uche
r
Payment No.To The County Treasurer
Law
Libra
ry C
ash
Fund
$Pay to the Order of
Dollars
Purpose:
Claim No. County Clerk
DeputyLAW LIBRARY FUND
S.A
. & I.
269
1 (2
000)
S. A
. & i.
269
3 (2
000)
PAY ROLL CLAIMS. A. & I. 2742 (2000) PAY-ROLL CLAIM No.
OnTo the Governing Board of Oklahoma,County, Oklahoma. (Name of Municipality)I
ForBy Affidavit under oath, the Pay Roll of REGULAR PERSONNEL of (Name of Department, Office, Sub-Office, etc.)
(Name of Dept., Office, Sub-Office, Station, etc.)By
(Person in Charge)is hereby certified to you for your consideration, covering the REGULAR pay-period fixed and established, of beginning I(State Period fixed) Tif
and ending , as follows, to-wit: FiledII
ACTION BY THE GOVERNING BOARDALLOWANCE BY ACTION OF GOVERNING BOARD Considered on IDeductions
Rate of Amount and allowed for PersonAmount(Words, not figures)ofFederalPay Allowed RetmtO.A.S.I. Ins. Savings
Warrant ,Tax Total Claimed $Amount Disallowed $Totals Allowed, and Charged to:
Allowed Total
$
And Credit:Warrants Issued $Federal Tax $State Tax $O.A.S.I. $Retirement $
Total Cr.Insurance $Savings $
Separate Encumbrance for O.A.S.I.obligation of Municipality
STATE OF OKLAHOMA, County of ss: AFFIDAVITCharge Appr'n Acct. and Credit Reserve
L the undersigned, on oath, depose and say that lam of of(Department or Agency) (Municipal Subdivision)(Official Title)
State of Oklahoma, and I am authorized to execute this affidavit by virtue of 62 0kl.St.Ann. § 304.1; that the persons whose names are listed on the above pay roll hold the positions or employment set forth after theirrespective names in the department that I am in charge of; that the appointment or employment of each said persons has heretofore been confirmed by the Governing Board and filed or entered of record by virtue of statute,ordinance, or contract; that each of said persons personally performed under my direct supervision the services for 1 which compensation is claimed. At a Lawful Meeting of the Governing BoardI further depose and say the foregoing pay roll is correct, that the several amounts claimed are correct, just, due and unpaid; and that the aggregate amount approved by me for payment is
on Ipersons, which said amount is subject toPayable to BY ORDER OF THE BOARD:(Insert words, not figures)the withholding of any taxes, or other deductions prescribed by law.Chairman
The approving officer further certifies that he has taken and filed the oath or affirmation required by 51 0kl.St.Ann. §§ 36.1-36.6, and said approving officer also certifies that every other officer or employee whose nameappears on said payroll has notified him in writing that he has taken and filed said oath or affirmation.
(Chairman, Co. Commissioners, Town Board, or Mayor, etc.)
MemberSubscribed and sworn to Before me this day MemberName of head of Department, Offices, Sub-Office, Institution orSchool
NOTE.of Title All County Claims must be signed by at least two members of the Board
(19Okl.St.Ann. §410.8)NOTE.My Commission Expires Any assignment of salary must be by separate instrument.
(See 62 Okl.St.Ann. §§304.1 and 304.2)Notary Public or Municipal Clerk
NAME Nature of Work
AddressPeriod ClaimedIf Less Than
Full Payroll Period
GrossAmount
DueStateTax
No.Signature of Employee
if required By GoverningBoard
Acct.No.
Title ofAccount
Amount
Appr'n Account No. Reserve Acct. No. Amount
RECORD OF ITEMS DISPOSED OF
-INSTRUCTIONS
RECORD OF TOOLS, APPARATU S, MACHINERY AND EQUIPMEENTCODE NO.
S.A. & I. 3511 (2000)
OFFICE OR DEPT. OF COUNTY OF
RECORD ACQUIRED
Name of Item Trade NameDescriptionItem No. Serial No. Model No.
If acquired by purchase and County actually has title thereto, give following information:Date acquired P.O. No. Warrant No.CostFederal Grant money used $ Federal Contract No. CFDA No.
OF ITEMS
If County does not have title but is holding under lease or rental contract, give following information:Date of Contract Purchase Price asShown on Contract $ Monthly rental
Location on Date of InventoryName of Vendor or Lessor AddressRemarks
Item No.Name of Item
Serial No.Indicate whether Sold, Traded or JunkedAmount received by sale or trade $ Date of DispositionTo Whom AddressRemarks When an ite
When an item is acquired by purchase with no trade in, enter in Schedule "A". When an item is traded in on another item,enter the item so Schedule "B" and the item acquired in Schedule "A ". When an item is sold or junked,not traded inenter in Schedule "B" and leave Schedule "A" blank.If the date of original acquisition is unknown, enter "on hand".If exact cost is unknown, enter estimate d cost and indicate "Est."
traded in
(Schedule B)
(Schedule A)
sold or traded
OFFICE OR DEPARTMENT OF COUNTY OF
Reporting Officer or Employee
-Title
.Balance on HandAcquired DuringReported Disposed ofon hand last Accounting During Accounting End of Accounting
PeriodReportName or Description of ToolsApparatus, Machinery and
Period PeriodCodeNo. Equipment Cost orNo.No. Original No.No. Original Original
of Purchaseor Est. or Est. or Est.of of ofItemsItems ItemsPriceCost Cost CostItems
Title
Dated and signed this ______ day of 20_____
I hereby certify that the following report, is a true and complete summary of all tools, apparatus, machinery and equipment, the original cost, or purchase price, ofwhich exceeds $250.00 acquired by purchase or held for use under a lease or rental contract or disposed of during the accounting period beginning
, 20_____ and ending , 20___, together with balances on hand at the beginning and endof the accounting period.
SUMMARY REPORT
S. A. & I. 3512 (2000)
GRAND TOTALS OR TOTALS FORWARD
WEEKLY TIME RECORD
Social Security NumberEmployee's Name
Employee's DivisionTitleTO: 12:00 Midnight SaturdayFROM: 12:01 a.m. Sunday (Minutes are to be entered
in case of overtime worked only)Scheduled Workweek:
DateDate
SaturdayWednesday Thursday FridayTuesdayMondaySunday
TotalHoursHoursHours HoursHoursHoursHours
Code Designations for Hours of Paid Leave:S - Sick Leave E - Enforced Leave C- Compensatory LeaveA - Annual Leave
To be completed only when hours worked per day are in excess of eight hours or if on Holidays or Weekends.
Total Time -
I certify that the above record of my daily and weekly hours workedare true and correct according to the best of my knowledge and belief.
APPROVED BY:
Supervisor:Signature of Employee:
S. A. & I. 3651 (2000)
HoursWorked
Hours ofPaid Leave
Time WorkBegan
a.m.p.m.
a.m.p.m.
a.m.p. M.
a.m.
p.m.a.m.
p.m.a.m.p.m.
a.m.
p.m.
Time Work
Endeda.m.
p. M.
a.m.
p. M.
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
a.m.
p. M.
a.m.
p.m.
EARNINGS RECORD
WORK WEEK
Department
Employee Name Exempt
Non-ExemptSocial Security Number
ACTIVITY THURSDAYWEDNESDAYTUESDAYMONDAYSUNDAY SATURDAYFRIDAYCODE
To the best of my knowledge and beliefthe employee listed hereon renderedthe services claimed.
I certify that the above record of mydaily and weekly hours worked is trueand correct to the best of my knowledgeand belief.
SupervisorSignature of Employee
Beginning Ending
S.A. & I. 3652 (2000)
TOTAL
HOURS
LeaveWithout
Pay
Vacation
sickPay
MilitaryPay
JuryDuty
EducationalLeave
With Pay
Holiday
Overtime
TOTAL
S.A.& I. 1-4001 (2000)
AFFIDAVIT FOR CONTRACTS AND PAYMENTS
STATE OF OKLAHOMA )SS
COUNTY OF )
The undersigned (architect, contractor, supplier or engineer), of lawful age, being first duly sworn,
on oath says that this invoice or claim is true and correct. Affiant further states that the (work, services or
materials) as shown by this invoice or claim have been (completed or supplied) in accordance with the
plans, specifications, orders or request furnished the affiant. Affiant further states that (s)he has made no
payment directly or indirectly to any elected official, officer or employee of the State of Oklahoma, any
county of local subdivision of the state, of money or any other thing of value to obtain payment of the
invoice or procure the contract or purchase order pursuant to which an invoice is required.
(Contractor, Supplier, Engineer, or Architect)
20Subscribed and sworn to before me this day of
Notary Public (or Clerk or Judge)
My Commission Expires:
Signed By:
NOTE: 62 Okl.St.Ann. § 310. 9 (B) AUTHORIZES COUNTIES EXECUTING MORE THAN ONECONTRACT, EXCEEDING $1,000.00 DURING THE FISCAL YEAR, WITH AN ARCHITECT,CONTRACTOR, SUPPLIER OR ENGINEER TO ACCEPT ONE AFFIDAVIT APPLYING TO ALLWORK, SERVICES OR MATERIALS COMPLETED OR SUPPLIED UNDER THE TERMS OFAWARDED CONTRACTS, OR WHICH ARE NEEDED ON A CONTINUAL BASIS; SUCHAFFIDAVIT TO BE IN LIEU OF ALL INDIVIDUAL AFFIDAVITS FOR EACH INVOICESUBMITTED IN RELATION TO SUCH CONTRACT.
RECEIVING REPORTRec. on Blanket P.O. County, Oklahoma
Vendor Date
F. 0. B. Rec. Dept./Project No
Delivery Ticket No Requisition No. Purchase Order No.(For Blanket P.O.)
Remarks
Received by Delivered byNOTE: Strike through any unused lines Copy I -White-County Clerk Copy 2-Canary-Send to Inventory Officer with Copy 2 of P.O.
Copy 3-Pink-Receiving Officer Copy 4-Goldenrod-Send to Purch. Agent with Orig. P.O.
S.A. & I. 4030 (2000)
20
QTY.ORD.
QTY.REC.
BACK-ORD. UNIT DESCRIPTION (include Condition of Goods) UNIT
PRICE TOTAL
TOTAL
County, OklahomaSA&I 1-4040 (2000)COUNTY PURCHASING OFFICE
County Court House, Oklahoma
Phone:
INVITATION TO BID
PLEASE REVIEW TERMS AND CONDITIONS ON REVERSESIDE RELATING TO SUBMISSION OF THIS BID.Notarized Affidavit completions and signature required on reverse side.
REQUIRED DELIVERY DATEBID CLOSING DATE AND HOUR
DATE OF DELIVERY:Days after award of Purchase Order
BID NUMBER
TERMS
ITEM QUANTITY UNIT OFISSUE
DESCRIPTION UNIT PRICE TOTAL
( )
DATE ISSUED
Page 1 of
TERMS AND CONDITIONS
Sealed bids will be opened in the Commissioner's Conference Room,1.County Courthouse, , Oklahoma, at the time and date shown on theinvitation to bid form.
Late bids will not be considered. Bids must be received in sealed envelopes (one to an envelope) with bid numberand closing date written on the outside of the envelope.
2.
Unit prices will be guaranteed correct by the bidder.3.
Firm prices will be F.O.B. destination.4.
Purchases by5. County, Oklahoma, are not subject to state or federal taxes.
6. This bid is submitted as a legal offer and any bid when accepted by the County constitutes a firm contract.
7. Oklahoma laws require each bidder submitting a bid to a county for goods or services to furnish a notarizedsworn statement of non-collusion. A form is supplied below.
Bids will be firm until8.(DATE)
AFFIDAVIT: I, the undersigned, of lawful age, being first duly sworn on oath say that he (she) is the agent authoriz-ed by the bidder to submit the above bid. Affiant further states that the bidder has not been a party to any collusionamong bidders in restraint of freedom of competition by agreement to bid at a fixed price or to refrain from bidding;or with any state official or employee as to quantity; quality or price in the prospective contract or any other termsof said prospective contract; or in any discussions between bidders and any state official concerning exchange ofmoney or other thing of value for special consideration in the letting of a contract; that the bidder/contractor has notpaid, given or donated or agreed to pay, give or donate to any officer or employee of the State of Oklahoma (orother entity) any money or other thing of value, either directly or indirectly in the procuring of the award of a con-tract pursuant to this bid.
daySubscribed and sworn before this
(SEAL)of
Firm:
Title:Signed by:My commission expires(Manual Signature of Undersigned)
Address: Phone:NOTARY PUBLIC (CLERK OR JUDGE)
State:City:
NOTE: Other terms and conditions can be added at the discretion of the county officers.
20,
Zip:
7
LIST INDIVIDUAL ITEMS
-~
=
S. A. & I. 4045 (2000)
BID RECORD
List Individual Bidders
Dept.
REQ.
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S. A. & 1. 1-4046 (2000)
VENDOR TELEPHONE QUOTE SHEET
Use to obtain bids for items costing under $5,000. on 6 months bid list
BUYER OBTAINING QUOTEDEPARTMENT DATE
PRICE IPRICE PRICELINE UNIT Supplies/Services DescriptionQUANTITYNO.NO, UNITUNIT TOTAL UNITTOTAL TOTAL
DAYSQUOTE GOOD FOR DAYSQUOTE GOOD FOR DAYSQUOTE GOOD FOR
QUOTE GOOD UNTIL (DATE) QUOTE GOOD UNTIL (DATE) QUOTE GOOD UNTIL (DATE)
VENDOR VENDOR VENDOR
REPRESENTATIVE REPRESENTATIVE REPRESENTATIVE
DELIVERY DATE DELIVERY DATE DELIVERY DATE
P.O. NUMBER P.O. NUMBER P.O. NUMBER
REQ. Number REQ.NUMBER REQ.NUMBER
LIST OF COMMONLY USED ITEMSTO
COUNTY OR STATE CENTRAL PURCHASINGS. A. & 1. 1-4050 (2000)
OFFICER FUNDDATE FISCAL YEAR/PERIOD COVERED
ESTIMATED QUANTITYTO BE USED IN PERIOD
ITEM NAME AND ADDRESS OFPOSSIBLE SUPPLIERDESCRIPTIONNO
NATURE OF RECOMMENDING OFFICER:
FOR USE BY CENTRAL PURCHASING:
PHYSICIAN'S LIENS.A.&I. 4060 (2000)
STATE OF OKLAHOMASS.
COUNTY OFKNOW ALL MEN BY THESE PRESENTS:
That pursuant to Title 42 Okl.St.Ann.§ 46, claim is herebymade, and a lien filed and entered on the Mechanic's and Materialman'sLien Docket in the Office of the County Clerk of County,Oklahoma; on the day of , 20 , as follows:-
PHYSICIAN CLAIMANT AND ADDRESS:
AMOUNT OF CLAIM:
Itemized statement for medical services is/is not attached hereto as Exhibit ''A''.
CLAIM AGAINST:Patient Name
Address
PARENTS ORLEGAL GUARDIANif a minor child
Address
Insurance Company
Address
OTHERADDRESS:
State reason for medical services provided for which these chargeswere incurred and dates, if appropriate such services were rendered:
Physician's Signature
Subscribed and sworn to before me, a notary public in and for the aboveday of , 20county and state on this
Notary PublicMy commission expires:
MECHANIC'S LIEN JOURNAL PAGE NO.
S. A. & 1. 4061 (1985)
Date When DESC. OF PROPERTYAMOUNTLIEN LINE NAME OF CLAIMANT BOOK PAGENAME OF OWNER REMARKSCLAIMEDNO. NO. Filed
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MECHANIC'S LIEN JOURNALDIRECT INDEXS. A.& I. 4062 (1985)
INAME OF OWNER NAME OF CLAIMANT
BOOKLINE PAGE NAME OF OWNER NAME OF CLAIMANT
BOOKLINE PAGE
MECHANICS LIEN JOURNALINVERTED INDEX
4063 (1985)S. A. & I.BOOK
NAME OF OWNER PAGENAME OF CLAIMANTLINE
NAME OF CLAIMANT NAME OF OWNERBOOK
LINEPAGE
STATEMENT OF CLAIM
Know all men by these presents: That I,have a claim against for the sum of
dollars, ($ and), due to me,that the claim is made for and on account of
and that such work was performed and materialsday ofsupplied by me between the
according to an itemized statement thereof hereto attached, marked ''ExhibitA'' and made a part of this statement: that such work, labor, and materialswere done in pursuance of a contract with
and was performed upon the building and premisesowned by said and described asfollows, to wit:
in said county and state; that the sum is just due and unpaid, and I have andclaim lien upon said building and upon the said premises on which the same is
as above set forth, according tosituated, to the amount of $the laws of the State of Oklahoma.
day ofDated this .
STATE OF OKLAHOMA )
COUNTY OF ). of lawful age, being
first duly sworn, upon oath, says: That he is the claimant mentioned inthe foregoing statement of mechanic's lien; that he had read said statementand knows the contents thereof; that the name of the owner, the name of thecontractor, the name of the claimant, the description of the property uponwhich the lien is claimed, and the items of the account as therein set forth,are just, true and correct.
day ofSubscribed and sworn to before me this .
Attach itemized statement.Note:
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ss
Notary Public
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MECHANIC'S LIEN
STATE OF OKLAHOMA ) )SSCOUNTY OF )
S.A.&I. 4064 (2000)
My Commission Expires:_________
S. A.&I. 4065 (2000)
NOTICE OF FILING LIEN STATEMENT
STATE OF OKLAHOMAss.
COUNTY OF
TO:
YOU ARE HEREBY NOTIFIED that the Claimant filed on the
day of a statement under oath claiming a
Mechanic's Lien, the same being No against the following describedproperty and the improvements thereon located, owned by you, for labor and materialsperformed and furnished by the Claimant, to-wit:
YOU ARE FURTHER NOTIFIED that under said lien statement, the Claimant claims
the amount due undera lien on the said premises in the sum of $contract with
for labor and materials performed and furnished upon the improvements erected on said premises
Dated this day of
The undersigned hereby certifies that the original of the foregoing was mailed to the person (orfirm) to whom directed, at the address above
. return receipt requested, with postage prepaidshown, by Certified Mail No
day ofthereon, this
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a
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County Clerk
Deputy
(Name)(Address)
)))
.
S.A.&I. 4066 (2000)
RELEASE OF MECHANIC'S LIEN
NO.
THIS IS TO CERTIFY that the indebtedness secured by the Mechanic's Lien filed
has been paid and said lien is hereby released and discharged of record and the county clerk ishereby authorized and directed to enter the satisfaction of said Lien on the Lien Journal.
day of, thisDated at
County ofSTATE OF
me the undersigned, a Notary Public, in and for said County and State, on
day of personally appearedthis
who executed the within andto me known to be the identical person
executed the sameforegoing instrument and acknowledged to me that
free and voluntary act and deed for the uses and purposesastherein set forth.
Given under my hand and seal the day and year last above written.
Notary PublicMy commission expires
20___. Book _______ Page _______ against the following described property
in the County of ______________________ State of ______________________
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INDIVIDUAL ACKNOWLEDGMENT
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,
, as before
JUDGMENT JOURNAL
S. A. & I. 4067 (1985)
ReceptionNo.
DateFiled
Plaintiff Defendant Book Page Date ofJudgment
Case No. Legal Description Remarks
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JUDGMENT JOURNAL
DIRECT INDEXS. A. & I. 4068 (1985)
r
NAME OF PLAINTIFF NAME OF DEFENDANT Book Page NAME OF PLAINTIFF NAME OF DEFENDANT Book Page
JUDGMENT JOURNAL
INVERTED INDEX4069 (1985)S. A. & I.
NAME OF PLAINTIFF NAME OF DEFENDANTPageBookNAME OF DEFENDANT NAME OF PLAINTIFF Book Page
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AUTOMATIC DEPOSIT TRANSMITTALCOUNTY, STATE OF OKLAHOMA
OFFICE OF COUNTY CLERK
NAMESS#(Please print or type exactly as name is on the account)
I hereby authorize County, State of Oklahoma, as perto deposit my payroll warrant for me in my62 Okl.St.Ann. § 471,19 Okl.St.Ann. § 623,checking or savings
account and for the DEPOSITORY FINANCIAL INSTITUTION (bank, savings & loan, credit union)named below, to make a credit entry to such account. If monies to which I am not entitledare deposited to my account, I authorize County, State of Oklahoma to direct thefinancial institution to return said funds. I understand the payroll date and frequency ofpayment currently being utilized by m employing count office will not be affected by mydecision to use electronic Fund Transfer. I understand while a change of enrollment is inprocess I may, in fact, get a payroll warrant instead of an electronic transfer.
Termination Of AgreementNew Enrollment Termination Date Change of AddressChange Enrollment
FINANCIAL INSTITUTION NAMEYour Bank)
StateCityThis authority is to remain in full force and effect until I give the
County Clerk 30 calendar days written notice using this form (SA&I 4072) toterminate this direct deposit agreement. his information is provided by me to facilitatemy personal banking needs and shall be considered personal and hold in confidence.Home Mailing Address
StateCity ZipTelephone Number (Home) (Work)
Employing County officeSignature Date
Please attach a voided check (deposit slips are not accepted,) or an official document fromyour financial institution showing the financial institution's routing number and youraccount number in space provided below. Allow 30 days for automatic deposit to commence
Please mail completed form to: County ClerkDirect Deposit, Payroll DepartmentATTENTION:
S. A. & I. 4072 (2000)
AUTOMATIC DEPOSIT AUTHORIZATION INSTRUCTIONS
I Social Security Number Enter your social security number.2. Name Type or print your name exactly as it appears on youraccount.3. Type of Account Indicate whether your account is a checking or savings
account.4. Type of Enrollment Indicate whether this is a new enrollment, change in
existing enrollment termination of direct deposit orchange in address. NOTE - Please allow one pay periodbefore the change will occur.Enter the name of the bank, savings and loan, or creditunion where your account is held, i. e. Liberty NationalBank.
5. Financial Institution Name
Enter the city and state of your financial institution.6. Financial Institution, City, State7. Mailing Address Enter your mailing address, city, state, zip code, home
and work telephone number(s)Enter the name of the County office you work for.8. Employing office
9. Signature and Date Sign and date the request form. NOTE - A request formcannot be proceed without your signature asauthorization.to a checking account, attach to this requestFor deposit10. Voided Check a VOIDED check(deposit slips are not accepted) from thefinancial institution of your choice so that we can use
the information to make proper deposit. For a depositto a savings account, provide a document from yourfinancial institution showing the financial institution'srouting number and your account number. NOTE - A requestform cannot be processed without this information. Thankyou.
WHAT HAPPENS NEXTWe will run a test to validate your account number.FIRST -
When your pay is included in the Direct Deposit system, you will receive an Advice of Depositinstead of a payroll warrant. The pay stub will not change, you will continue to receive a recordof your earnings.if you should have any problems, follow the procedures listed below:1. Call your bank and ask for Commercial Direct Deposit Assistance. Advise them that you are on
direct deposit through "ACH" (Automated Clearing House) If you still have problems, ask tospeak to an Officer of the Bank, a Teller Supervisor or a Customer Service Representative.Write down the names of the people you talk to and the phone number you called.
County Clerk, DirectIf you are not satisfied with the results, contact the2.Deposit, Payroll Department. You must have completed Step I before calling the Direct DepositUnit. We will need the Phone Numbers and Names of the people you talked with at your bank.
NO.TRANSFER DOCUMENT
SA&I 1-9001 (2000)
20COUNTY, OKLAHOMA DATE
RECEIVING DEPT./PROJECTISSUING DEPT./PROJECT
CHARGE ACCOUNT NO.CREDIT ACCOUNT NO.
ISSUED BY RECEIVED BYDeputy Receiving Officer
APPROVEDAPPROVEDDept. Head Dept. Head
INSTRUCTIONS: To Transfer Materials, Supplies, Equipment, and Machinery Between Officers, Districts or ProjectsCopy 1 -White-Receiving Dept. Copy 2-Canary-Inventory Officer Copy 3-Pink-Issuing Dept./Must Notify County Clerk if Equip. or Mach.
QUANTITY UNIT DESCRIPTION OF ITEMS UNIT PRICE TOTAL
TOTAL
PROJECT INVENTORY RECORDS. A. & I. 1-9002 (2000)
OFPAGECOUNTY, OKLAHOMA
PROJECT NO.DATE STARTEDDISTRICT OR DEPT.DATE COMPLETED
DESCRIPTIONAND LOCATION
TOTAL PROJECT MATERIALS COST
INSTRUCTIONS: When project is complete, transfer out any unused materials orsupplies to another project or to the warehouse. Attach acompleted copy of this form to a ''Summary Report ofConsumable items, ''S.A. & I. Form No. 1-9003 (2000).
Copy 1-White-To Inventory Officer Copy 2-Canary-Retained by Receiving Officer
DATE DOCU. NO. ORTRANSFER OUT NO.
QUANTITY UNIT DESCRIPTION UNITCOST
AMOUNTI N (OUT)
ACCUMULATEDBALANCE
SUMMARY REPORT OF CONSUMABLE ITEMS
DEPARTMENT OF ,OKLAHOMA, COUNTY OFThe County Road and Bridge InventoryI hereby certify that the following report to The Board of County Commissioners, or
Officer is a true and complete summary of all supplies and materials disposed of and/or projects completed during the reporting period begin-and ending
DateReporting Officer or Employee
TOTAL
ning
S. A. & I. 1-9003 (2000)
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20
Place orProject No.
DateStarted
Date Completed Dis-posed or Consumed DESCRIPTION QUANTITY UNIT Cost Per
Unit TOTAL
Consumable Item Stock RecordSA&I 1-9004 (1982)SECTIONCOUNTY OF NUMBER __________
BINSTOCKNUMBERNUMBERITEM NO.CARDNUMBERDESCRIPTION
PART TRANSFERREDNUMBER TO CARD NO.SPECIFICATIONUNIT TRANSFERREDPERPRICEWAREHOUSE FROM CARD NO.
ISSUED BALANCERECEIVEDPURCHASE1-9001 Quantity ValueValue Date QuantityORDER NO. Quantity1-4030 Value
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FIXED ASSET RECORD - PROPERTY AND EQUIPMENT(Autos, Office Furniture and Equipment, Road Machinery and Equipment, Radios, Etc.)
IDENTIFICATION NO.COUNTY
INVENTORY: DATE BY DATE BY DATE BY
REMARKS:
As to items under rental contract, the date of acquisition is whenever final payment is made and title is delivered.
Federal Grant money used $_____________Federal Contract No.______________________________CRDA No.______________________________
S. A. & I. 9005 (2000)
FUND / ACCOUNTOFFICE OR DEPT.
RECORD OF ACQUISITION
TRADE NAMEITEM
DESCRIPTION
SERIAL NO. MOTOR NO. MODEL No.ESTIMATED LIFE
ADDRESSVENDOR OR LESSOR
If acquired by purchase and County actually has title thereto, give following information:
P.O. NO.COST $ WARRANT NO,DATE ACQUIREDLabel
If County does not have title but is holding under lease or rental contract, give following information:
PAYMENT CONTRACT WITH MONTHLY RENTAL $DATE OF CONTRACT ACQUISITION DATEPURCHASE PRICE $CONTRACT NO.
RECORD OF DISPOSITION
SOLD OR JUNKED (circle one) WHY?
AMOUNT RECEIVED BY SALE $ MISC. RECEIPT NO.DATE OF DISPOSITION
ADDRESSTO WHOM SOLD
PAYMENT REGISTER
WARRANT NO. $ BALANCE$ PAYMENTDATENO.
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WEEKLY WAREHOUSE SUMMARY
S. A. & 1. 1-9006 (2000) DATE
County Road & Bridge Inventory OfficerTO:
DistrictFROM- County
SUBJECT: Receiving Report and Transfer Document (Warehouse Only)
Week Ending
Balance Last Report $
Receiving ReportsAdd:
Deduct- Transfer Documents
Warehouse Stock Balance $