HomeMy WebLinkAbout11-12 Annual FeeCity of
Cape Canaveral
VENDOR:
Florida Department of Economic Opportunity
Special District Information
107 E. Madison Street, MSC400
Tallahassee, FL 32399-6508
SHIP TO:
PURCHASE ORDER
No. 0000005452
BILL TO:
Cape Canaveral
Attn: Finance Dept.
P.O. Box 326
Cape Canaveral, FL 32920
VENDOR NO.
VENDOR PHONE NUMBER
TERMS
DATE
REQUIRED DELIVERY DATE
FL-DOEO
0
11/21/2011
SHIPPING INSTRUCTIONS
(none)
ITEM
QTY
U/M
DESCRIPTION/TASK
PRD CODE
ACCOUNT
UNIT PRICE
AMOUNT
1
1.00
1 Invoice 25154 Special District 1
104-023-571-520000
175.00
175.00
TAXABLE: No
CONFIRMING:
SUBTOTAL: 175.00
TAX: 0.00
SHIPPING: 0.00
TOTAL: 175.00
IMPORTANT: OUR ORDER NUMBER MUST APPEAR ON EVERY INVOICE AND PACKAGE
The rite is reserved to cancel this order if net filled within the contract time, if specified. The conditions of this order are
not to be modified by any verbal understanding. Invoices and packages must bear this order number. THIS PURCHASE ORDER VOID
AFTER 9/30/2011.
FLORIDA DEPARTMENT OF ECONOMIC OPPORTUNITY Invoice No.: 25154 Date Invoiced: 10/27/2011
FY 2011/2012 SPECIAL DISTRICT FEE INVOICE AND UPDATE FORM DEO use only: Post to: Special District Information Program
instructions: In accordance with Sections 189.412 and 189.427, F.S., and Chapter 9B-50, F.A.C., please remit the fee due payable to the
Department of Economic Opportunity OR complete the Zero Annual Fee Certification Section, as appropriate. In addition, review the
information below about the district and update as necessary. Provide backup documentation if the district's name or status has changed.
By the postmarked due date, mail the payment and this signed form to the Department of Economic Opportunity, Office of Financial Mgmt.,
107 E. Madison Street, MSC 120, Tallahassee, Florida 32399-4124. Direct questions to (850) 717-8430.
ANNUAL FEE: $175.00 1 LATE FEE: $0.00 1 RECEIVED: $0.00 FEE DUE, POSTMARKED BY 12/28/2011: $175.00
District's Name, Registered Agent & Office*:
Cape Canaveral Free Public Library Telephone: (321) 868-1230
Mr. David L. Greene
Fax: (321) 868-1224
Post Office Box 326
Status*: Dependent
Cape Canaveral, FI 32920 Creation Document: On File
Map: On File
Last Update: 10/05/2010
Website:
www.cityofcapecanaveral.org
E-mail:
---------------------------------------------------------------------------------------
d.greene@cityofcapecanaveral.org
County(ies):
Brevard
Local Governing Authority*:
City of Cape Canaveral
Function(s)*:
Library - Local
Date Established:
07/15/1986
Creation Documents*:
City Ordinances 11-66 and 14-86
Statutory Authority*:
Section 189.4041, Florida Statutes
Board Selection*:
Local Governing Authority Appoints
Authority to Issue Bonds*:
No
Revenue Source*:
Ad Valorem
*Explanations
Registered Agent:
The person designated by the special district to accept due process on behalf of the special district
Status:
Independent or Dependent - see Section 189.403, F.S.
Local Governing Authority:
The governing body of a unit of local general-purpose government
Functions:
The function/purpose of the special district
Creation Documents:
Ordinance, Resolution, Statute, Special Act, Court Decree, Interlocal Agreement, etc.
Statutory Authority:
The Florida Statute governing the function of the special district
Board Selection:
Appointed, Appointed/Elected, Elected, Governor Appoints, Local Governing Authority Appoints, Same as
Local Governing Authority, Similar to Local Governing Authority, Other
Authority to Issue Bonds:
Yes or No
Revenue Sources:
Ad Valorem, Agreement, Assessments, Bond Issuer Fees, Co., Donations, Fed, Fees, Other, Investments,
Grants, Municipality, Non -Ad Valorem, Priv. Enterprise, Sales Surtax, Sales/Leases, State, TIF, Tolls, None
CERTIFICATION: I, the undersigned registered agent, do hereby certify that the information above is accurate and complete as of
this date. It does X or does not need to be changed.
Registered Agent's Signature:
(9a 4 K )"t he� Date: 11/21/11
ZERO ANNUAL FEE CERTIFICATION SECTION- If eligible, the special district may request a zero annual fee instead of making a
payment by having the registered agent certify to the following:
1. This special district is not a component unit of a general purpose local government as defined in the Governmental Accounting
Standards Board's Statement No. 14, issued in June 1991 effective after December 15, 1992, as amended.
2. This special district is in compliance with the reporting requirements of the Department of Financial Services.
3. This special district reported $3,000.00 or less in annual revenues to the Department of Financial Services on its Annual Financial
Report for Fiscal Year 2009/2010 (special districts created after that fiscal year must attach a current income statement verifying
$3,000.00 or less in revenues for the current fiscal year).
4. This certification will be returned to the Department at the address above postmarked by 12/28/2011 and,
5. This special district understands that if the Department determines any of these items to be inaccurate, this special district must
pay the appropriate fee when invoiced. The Department will verify these statements within 30 days of receiving this form.
I, the undersigned registered agent, do hereby certify that to the best of my knowledge and belief, ALL of the above statements contained
herein and on any attachments hereto are true, correct, complete, and made in good faith as of this date. I understand that any
information I give may be investigated and verified with the Department of Financial Services and the Auditor General.
SIGN ONLY IF ELIGIBLE FOR AND REQUESTING A ZERO ANNUAL FEE:
Registered Agent's Signature: Date:
Department Use Only: _Verified and Approved _Denied - Reason(s):
DETACH AND RETURNTHIS PORTION WITH YOUR PAYMENT.
DEO-SDIP-001 Effective 10/01/2011
---- ----- ---------------------------------
DETACH AND KEEPTHIS PORTION FOR YOUR RECORDS.
FLORIDA DEPARTMENT OF ECONOMIC OPPORTUNITY Invoice No.: 25154 Date Invoiced: 10/27/2011
FY 2011/2012 SPECIAL DISTRICT FEE INVOICE AND UPDATE FORM RECEIPT Postmarked Due Date: 1212812011
Cape Canaveral Free Public Library ANNUAL FEE LATE FEE RECEIVED FEE DUE
$175.00 $0.00 $0.00 1 $175.00