New York State Education Department                       
                         Office of Management Services                          
                                 State Aid Unit                                 
                                 (518) 474-2977                                 
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                         District Code:    200701               
      LONG LAKE CSD                      Vendor ID:  1000002002                 
                                                                                
                                                                                
                                                                                
     2013-14 Certificate of Excess Cost Aid for Students with Disabilities      
                                                                                
 1. TOTAL EXCESS COST AID (less Estimated or calc)                 $38,008.00   
 2. Total Aug-Nov State Share Medicaid Paid By DOH                    $920.51   
 3. Total Overpayments Deducted                                         $0.00   
 4. December Net Payment                                            $8,581.49   
    (Line 1 X .25 minus St Sh Med & Overpayments)                               
 5. Check Date                                                     12/13/2013   
                                                                                
 6. TOTAL EXCESS COST AID (less Estimated or calc)                 $38,008.00   
 7. Total Dec-Feb State Share Medicaid Paid by DOH                  $1,118.44   
 8. Total Overpayments Deducted                                         $0.00   
 9. March Net Payment                                              $15,985.16   
    (Line 6 X .70 less previous EC, St Sh Med & O/P's )                         
10. Check Date                                                     03/14/2014   
                                                                                
11. TOTAL EXCESS COST AID (less Estimated or calc)                 $38,008.00   
12. Total Mar-May State Share Medicaid Paid by DOH                  $1,219.58   
13. Total Foster Care Deducted                                          $0.00   
14. Total Overpayments Deducted                                         $0.00   
15. June Net Payment                                                $4,481.62   
    (Line 11 X .85 less previous EC,St Sh Med,FC, & O/P's)                      
16. Check Date                                                     06/13/2014   
                                                                                
17. TOTAL EXCESS COST AID (less Estimated or calc)                 $38,008.00   
18. Total June & July State Share Medicaid Paid by DOH                $805.65   
19. Total Foster Care Deducted                                          $0.00   
20. Total Overpayments Deducted                                         $0.00   
21. August Net Payment                                              $4,895.55   
    (Line 17 X 100% less previous EC,St Sh Med,FC, & O/P's)                     
22. Check Date                                                     08/15/2014   
                                                                                
23. TOTAL EXCESS COST AID                                          $38,008.00   
24. September Net Payment                                               $0.00   
    (Line 23 less all previous EC,St Sh Med, FC, & O/P's)                       
25. Check Date                                                                  
                                                                                
 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)                         
                                                                                
                                                                                

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