New York State Education Department
Office of Management Services
State Aid Unit
(518) 474-2977
TREASURER District Code: 031301
DEPOSIT CSD Municipal Code: 030774300100
171 SECOND ST Date of Payment: DEC 15, 2008
DEPOSIT, NY 13754-1397 Amount of Payment: $191,216.67
2008-09 Certificate of Excess Cost Aid for Students with Disabilities
1. TOTAL EXCESS COST AID (less Estimated or calc) $800,850.00
2. Total Aug State Share Medicaid Amount
3. Total Sept State Share Medicaid Amount
4. Total Oct State Share Medicaid Amount
5. Total Nov State Share Medicaid Amount $8,995.83
6. December Gross Payment (Line 1 X .25 - tot St Sh Medicaid) $191,216.67
7. December Net Excess Cost Payment $191,216.67
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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