Appendix 6.  


Form A. C. 896 (1961)
Annual or Supplemental STATEMENT*
OF
HOUSING AND URBAN RENEWAL INDEBTEDNESS
(Name of Municipality)
__________ COUNTY, NEW YORK
PREPARED AS OF
_______, 19_
*SEE INSTRUCTIONS, PAGE 2
(continued)
Form A. C. 896-1 (1961)
INSTRUCTIONS
If a city, town or village has any unpaid indebtedness which was contracted to effectuate any of the purposes of Article 18 of the New York State Constitution, as implemented by the Public Housing Law, the General Municipal Law or any other general or special law, within 60 days after the close of its fiscal year an annual verified statement of its housing and urban renewal debt-contracting power must be filed with the State Comptroller and the State Commissioner of Housing. In addition thereto, not more than 15 nor less than 3 days before any such municipality contracts any indebtedness for housing or urban renewal purposes, it shall file with the same officials a verified supplemental statement of its housing and urban renewal debt-contracting power, The annual statement shall contain the items of indebtedness enumerated in Section 135.00 of the Local Finance Law, which are contracted by the municipality for the purposes set forth in paragraph a of Section 150.00 of such law, and should be prepared as of the close of such fiscal year. The supplemental debt statement should indicate any additions to, omissions of or changes in the items or statements contained in its previous annual debt statement. (Local Finance Law, Section 151.00).
A duplicate copy of every annual or supplemental housing and urban renewal debt statement must be filed within the same respective period of time with the clerk or other corresponding officer of such municipality. However, in the case of a city containing more than one county, a copy of such statement shall, in addition thereto, be filed in the office of the chief fiscal officer thereof. (Local Finance Law, Section 151.00).
The term "housing authority", as used in the Local Finance Law, means "authorities" as that term is defined in Section 3 of the Public Housing Law, as amended from time to time. (See Local Finance Law, Section 2.00(13)).
In the appropriate spaces indicate whether the statement is annual or supplemental. The supplemental debt statement must also contain a statement as to the amount of the proposed housing or urban renewal debt to be contracted.
Form A. C. 896-2 (1961)
(Supplemental, Annual) STATEMENT OF HOUSING AND URBAN
RENEWAL INDEBTEDNESS
The following is a statement of the power of the _____ of _____, in the County of _____, New York, to contract indebtedness for housing and urban renewal purposes prepared as of ____, 19_, pursuant to Title 11 of Article 2 of the Local Finance Law:
AVERAGE ASSESSED VALUATION
Image 1 within 2 CRR-NY App. 6
Average Assessed Valuations
(One-Fifth of Total of Column 4)
 
$
 
NOTE: The Local Finance Law, Section 2.00(7), defines "Completed Assessment Roll" as one which has been "completed, verified and filed by the assessors". The amounts to be used in the columns above would be the amounts shown on such rolls as filed after the hearing of grievances, regardless of subsequent changes. Assessed valuation of "Pension Exempt Property" should be entered only by cities with a population of 125,000 or more.
HOUSING AND URBAN RENEWAL DEBT LIMIT
Multiply "Average Assessed Valuation" (Above) by.02
 
$ __
NET MARGIN OF DEBT-CONTRACTING POWER
FOR HOUSING AND URBAN RENEWAL PURPOSES
Housing and Urban Debt Limit (Above)
 
 
$__
Less: Net Housing and Urban Renewal Indebtedness
(Page 4)
 
 
$__
Margin
 
 
$__
PERCENTAGE OF DEBT-CONTRACTING POWER OF MUNICIPALITY
EXHAUSTED FOR HOUSING AND URBAN RENEWAL
Divide "Net Housing Indebtedness" (Page 4) by "Housing
Debt Limit" (Above) and Enter Result Here
 
 
__
PROPOSED HOUSING AND URBAN RENEWAL DEBT *
The Amount of the Proposed Housing and Urban Renewal
Debt to be Contracted in Connection with which this
Statement is Filed
 
 
$__
* Required only for Supplemental Statements.
Form A.C. 896-3 (1961)
HOUSING AND URBAN RENEWAL DEBT STATEMENT
INCLUSIONS
1. Borrowings for housing and urban renewal purposes.
 
See Local Finance Law, Sections 135.00(a, 1) and
 
151.00(b).
 
$____
2. Real property liabilities for housing and urban re-
 
____
newal purposes.
See Local Finance Law, Sections 135.00(a, 2) and
 
151.00(b).
 
3. Contract liabilities for housing and urban renewal
 
(a)
____
purposes (other than at '4' and '5' below).
Separate
 
according to Local Finance Law, Section 135.00(a, 3).
 
(b)
____
See Local Finance Law, Sections 135.00(a, 3) and
 
151.00(b).
 
4. Contract liabilities: Housing guarantees; subsidies.
 
(a)
____
Separate according to Local Finance Law, Section
 
135.00(a, 4).
 
(b)
____
See Local Finance Law, Sections 135.00(a, 4),
 
143.00 and 151.00(b).
 
5. State loans to certain housing authorities and mu-
 
____
nicipalities.
 
See Local Finance Law, Sections 135.00(a, 5) and
 
151.00
 
6. Judgments, claims, awards and determinations aris-
 
ing out of or connected with housing and urban re-
 
(a)
____
newal purposes.
Separate according to Local Finance
 
Law, Section 135.00(a, 6).
 
(b)
____
See Local Finance Law, Sections 135.00(a, 6) and
 
151.00(b).
 
7. Pay-as-you-go financing for housing and urban re-
 
____
newal purposes.
 
See Local Finance Law, Sections 122.00, 135.00(a, 8)
 
and 151.00(b).
 
EXCLUSIONS
1. Assets of sinking funds for housing and urban re-
 
$
____
newal debt.
 
See Local Finance Law, Sections 136.00(10) and
151.00(b, 3).
 
2. Cash on hand for housing and urban renewal debt.
 
____
See Local Finance Law, Sections 136.00(11) and
 
151.00(b, 3).
 
3. Appropriations for housing and urban renewal debt.
 
____
See Local Finance Law, Sections 136.00(12) and
 
151.00(b, 3).
 
4.
TOWNS OR VILLAGES WITH A POPULATION
 
LESS THAN 5,000:
 
Indebtedness for housing and urban renewal pur-
 
poses arising from a guarantee, a loan by the State
 
to a housing authority acting as an instrumentality
 
of such town or village or a contract for a periodic
 
subsidy.
(Compute according to subdivision 9 of Sec-
 
tion 136.00 of the Local Finance Law).
 
____
See Local Finance Law, Sections 151.00(b, 1),
 
143.00.
 
5.
CITIES OR VILLAGEES WITH A POPULATION
 
OF 5,000 OR MORE:
 
The unpaid balances of any loan or loans by the
 
State to any housing authority acting as an instru-
 
mentality of the city or village.
No exclusion is
 
permitted, if such housing authority is in default in
 
payment of such loan or loans.
 
____ See Local Finance Law, Section 151.00[b, 2(a)].
6.
CITIES OR VILLAGES WITH A POPULATION OF
 
5,000 OR MORE:
 
Indebtedness for self-liquidating housing projects
 
____
See Local Finance Law, Sections 151.00[b, 2(b)],
 
152.00.
 
7.
CITIES OR VILLAGES WITH A POPULATION OF
 
5,000 OR MORE:
 
Indebtedness for housing and urban renewal pur-
 
poses permitted to be deducted pursuant to Item (c)
 
of Subdivision 2 of Paragraph b, Section 151.00 of
 
the Local Finance Law.
 
____ See Local Finance Law, Section 151.00[b, 2(c)].
8.
CITIES OR VILLAGES WITH A POPULATION OF
 
5,000 OR MORE:
 
Indebtedness for urban renewal purposes permitted to
 
be deducted pursuant to Item (d) of Subdivision 2 of
 
Paragraph b, Section 151.00 of the Local Finance
 
Law.
 
____ See Local Finance Law, Section 151.00[b, 2(d)].
Gross Housing and Urban Renewal Indebtedness
 
 
$ ____
Less: Exclusions
 
 
____
Net Housing and Urban Renewal Indebtedness
 
 
$ ____
____
Form A.C. 896-4 (1961)
SCHEDULE A
This schedule should show the bonds, notes or other obligations which have been authorized to be issued for housing and urban renewal purposes to the extent to which obligations have not been issued.
Image 2 within 2 CRR-NY App. 6
The following symbols may be used above: Serial Bond--SB; Bond Anticipation Note or similar obligation--BAN; Capital Note--CN; Revenue Anticipation Notes--RAN.
VERIFICATION BY CHIEF FISCAL OFFICER
STATE OF NEW YORK
 
SS:
COUNTY OF _____
________, being duly sworn, deposes and says:
That he is the duly (elected) (appointed), qualified, and acting chief fiscal officer of the ______ of ______ in the County of ______, New York; that he prepared and has read the foregoing (annual) (supplemental) debt statement of housing and urban renewal indebtedness and knows the contents thereof; that the same is true to (his) (her) own knowledge except as to the matters therein stated to be alleged upon information and belief; and that as to those matters he believes it to be true.
Sworn to before me this
__
day
 
of
 
(Signature)
_________
, 19
_
 
(Title)
 
(Mail Address)
Notary Public
________
(The statement of housing and urban renewal indebtedness must be verified by the chief fiscal officer. In towns such officer will be the supervisor or presiding supervisor; in villages and counties, the treasurer, except in the County of Suffolk, the county auditor. For cities, see definition in Local Finance Law, Section 2.00(5). If a municipality has no chief fiscal officer, this statement must be verified by the finance board.)