New York State Education Department                       
                         Office of Management Services                          
                                 State Aid Unit                                 
                                 (518) 474-2977                                 
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                         District Code:    200401               
      INDIAN LAKE CSD                    Vendor ID:  1000001991                 
                                                                                
                                                                                
                                                                                
     2013-14 Certificate of Excess Cost Aid for Students with Disabilities      
                                                                                
 1. TOTAL EXCESS COST AID (less Estimated or calc)                 $77,928.00   
 2. Total Aug-Nov State Share Medicaid Paid By DOH                  $2,630.57   
 3. Total Overpayments Deducted                                         $0.00   
 4. December Net Payment                                           $16,851.43   
    (Line 1 X .25 minus St Sh Med & Overpayments)                               
 5. Check Date                                                     12/13/2013   
                                                                                
 6. TOTAL EXCESS COST AID (less Estimated or calc)                 $77,928.00   
 7. Total Dec-Feb State Share Medicaid Paid by DOH                  $1,879.12   
 8. Total Overpayments Deducted                                         $0.00   
 9. March Net Payment                                              $33,188.48   
    (Line 6 X .70 less previous EC, St Sh Med & O/P's )                         
10. Check Date                                                     03/14/2014   
                                                                                
 Deposit will take place sometime during the payment day and funds will be      
 available the following day.                                                   
 (ST-3 Code A3101 Basic Formula Aid - Excess Cost Only)                         
                                                                                
                                                                                

NYSED HOME PAGE | STATE AID HOME PAGE | DISTRICT HOME PAGE