Affidavit and Revenue Certification. A/1 (City), state

Transcription

1 Affidavit and Revenue Certification > ENTITY NAME ^/exmilian Parish A/1 (City), state ANNUAL SWORN FINANCIAL STATEMENTS AND CERTiFlGATlON OF REVENUES 75,000 OR LESS (if appiicabte) The annual sworn financial statements are required by Louisiana Revised Statute 24:514 to be filed with the Legislative Auditor within 90 days after the close of the fiscal year. The certification of revenues of 75,000 or less, if applicable, is required by Louisiana Revised Statute 24:513(J)(1)(c)(i)(aa), Personally came and appeared before the undersigned authority, S /? A rcae. r (enter officer name), who, duly sworn, deposes and says that hi luv the IW financial III IWI IWIMI statements SffcMfcWI I IWI IkW herewith ilwiwvvisii ^IVWII given i.nwi9s^ili present fairly the financial position of ^ Cii Afi (enter entity name) as of Qf^i Pmhi>w OiU(, _(enlity'syear-end), and J the results of operation^ for the year then ended, in accordance with the basis of accounting described within the accompanying financial statements. (Complete if applicable) In addition, fp rri^pir ^ n-wrai (officer name), who, duly swom, deposes and says that Jy't; (entitv (entity n: name) received 75,000 or less in revenues and other sources for the year ended ^ ^ ^ i, y and accordingly, is not required to have an audit for the previously mentioned year. Officer's Signature Swom to and subscribed before me this 13th day of MARCH, X For Office Use Only NOTARY P EDWARD G. SAAL, Under piovtiiom of state law, this report will become a public document on itw Monday fohowing the release date. A copy of tt)e report will be submitted to appropriate public offfdais and be available for public irtspectlon at the Baton Rouge office of the Louisiana LegislaSva Auditor and, where appropriate, at the ^fice of the parish dark of court Release Date APR RE & SEAL BAR ROLL // Please Complete This Section Officer's Name R Pirclnev Officer's Title Address P. 0 P.ny, -S's I City, Zip o iac/ci\n, I Ph: Cell/Land 0UU3i (^u«v^c(ciw?5'iir >^filsjsiatt n/t Please return the completed form within 90 days of vour entity's vear-end to Louisiana Leoislative Auditor - Local Government Services: Post Office Box Baton Rouge. LA updated era/ie

2 statement A Pages (Agency Name) yv)k-q-au.m >1 firl S,icJ,e-fu Statement of Cash Receipts and Disbursements For the Year Ended ^n/a (Year-End) RECEIPTS (Provide Brief Description); 1- tm*' I 'nhte ( fiiy'i d rcw^f^r /c/gy>^(i ^ J J 6. Total receipts (add lines 1-5) DISBURSEMENTS (Provide Brief Description); 7^ 9-4*^)7(9 12. P.Vy)i.-ihtYi^riti (7atfnT;gr\ />VUC _ General ios37.f^ mssrl it ii'o- - ep7-7v-s1.- '79?' 13. Total DisbuVsements (add lines 7-12) ^ 14. Change in fund balance (Lines 6 minus 13) 15. Balance at beginning of year 16. balance (deficit) at end of year (Add lines 14-15) -This amount also goes on line 12. Statement B _ Other Total 11D^ 2Z. S4. m.- A 3U^tt/sta - LiSQ-^ m- IV 5^ S5^2iL- r tfp/7/ C )MipM,"fev' pnimoni a.tt^cj'fg^ PLEASE RETAIN A COPY OF THE COMPLETED FINANCIAL STATEMENTS FOR YOUR RECORDS Please return the completetl form within 90 days of vour entity's year-end to Louisiana Legislative Auditor - Local Govemment Services: Post Office Box Baton Rouoe. LA UDda«i B»I#

3 Statement B Page 4 (Agency Name) CulUiYQ,! 5ir^<f<rf ^ Balance Sheet, on.b^rg^rvilj^r r?/. 3LbiU (Year-End) General Other Total ASSETS (balances at year-end) -Give bnef description- T" # V 1 /JX/1 LIABILITIES AND FUND BALANCE (at year-end): 7. Liabilities (give brief description); 8. Xi'c^Ul f i Q- Tfjf-Ql f.qfil h/ 10. ^ Total Liabilities (add lines 7-10) 12. balance (amount from Line 16 on Statement A) 13. Other 14. Total Liabilities and Balance (add lines 11-13) 2. Investments (fair value) on hand CDs- 3. Office furnishings (Cost of desks, etc) 4 Equipment (Cost of fax machine, etc) 5. Other (brief description) 6. Total Assets (add lines 1-5) ar/560.- PLEASE RETAIN A COPY OF THE COMPLETED FINANCIAL STATEMENTS FOR YOUR RECORDS Please return the completed form within 90 davs of vour entity's year-end to Louisiana. Legislative Auditor - Local Government Services. Post Office Box Baton Rouge. LA updated 8/3/1 e

4 11:38 AM 03/04/17 Accrual Basis Gueydan Museum and Cultural Art Society Profit & Loss January through December 2016 Jan - Dec 16 Ordinary Income/Expense Income Grants Hotel Motel Tax Total Grants 10, Investments Bank of Gueydan, Short-term CD Vermilion Bank CD BIdg Total Investments VB Building Savings ' Program Income Artist Sales Boutique Sales Donations Donations for bidg repairs Dues ' raisers Memorials , Total Program Income 5, raiser donations raiser Sweets Dividends Total Income Expense Business Expenses raiser Expense Operations Artist Sales 80% Building Maintenance Building Repairs Insurances Miscellaneous Sect of State Miscellaneous - Other Total Miscellaneous Office Expense Postage Office Expense - Other , , , Total Office Expense Payroll Taxes - Employer ' Reception Expense Salary Security Telephone and Internet 1, Utilities 1, Operations Other Total Operations 21, Miscellaneous Water Visitor refreshments Miscellaneous - Other Total Miscellaneous Total Expense Net Ordinary Income Net Income , Pagei

5 11:40 AM 03/04/17 Accrual Basis Gueydan Museum and Cultural Art Society Balance Sheet As of December 31, 2016 Dec 31,16 ASSETS Current Assets Checking/Savings Bank of Gueydan - Operating Vermilion Bank Bldg Vermilion Bank -Memorial Total Checking/Savings Total Current Assets Other Assets Bank of Gueydan CD Savings Vermilion Bank - Gayle CD Savings Total Other Assets TOTAL ASSETS LIABILITIES & EQUITY Uabillties Current Liabilities Other Current Liabilities Payroll Liabilities SS & Med WH Federal Tax WH State Tax WH Total Payroll Liabilities Total Other Current Liabilities Total Current Liabilities Total Liabilities Equity ' Opening Balance Equity Unrestricted Net Assets Net Income Total Equity TOTAL LIABILITIES & EQUITY 6, , , , , , , , , , , , Pagel

6 statement C Pages CAiH-UYr,/.Sflf.ip/j (Agency Name) Schedule of Compensation, Benefits and Other Payments to Agency Head or Chief Executive Officer (Required Form - Please Submit Completed Form Per Attached Instructions) For the Year Ended.(Year-End) Agency Head Name:and Title:. Purpose Dollar Amount 1. Salary 2 Benefits-insurance Benefits-retirement Benefits-other (describe) Benefits-other (describe) 5, 6. Benefits-other (describe) Car allowance 7 8 Vehicle provided by government (if reported on.your w-2) 8 9. Per diem Reimbursements Travel Registration fees Conference travel Housing Unvouchered expenses (example, travel advances, etc.) Special meals Other TOTAL (enter total of line 1-17) to, Please check here if the Agency Head does not receive any compensation, benefits, and other payments. (Act 462 of the 2015 Legislative Session allows nongovernmental entities or not-for-profit (quasipublic) entities to report on the Act 706 schedule only those, payments to the agency head that are derived from the public funds.) PLEASE RETAIN A COPY OF THE COMPLETED FINANCIAL STATEMENTS FOR YOUR RECORDS Please return the completedtorm within 90 davs.ofvour entity's veafrend to Louisiana-LeQislative Auditor - Local Government.Services. Post Office;Box Baton Rouae. LA updated an/ie