New York State Education Department
Office of Management Services
State Aid Unit
(518) 474-2977
TREASURER District Code: 130502
DOVER UFSD Municipal Code: 130923800200
PO BOX 6311 Date of Payment: DEC 15, 2008
DOVER PLAINS, NY 12522 Amount of Payment: $486,231.50
2008-09 Certificate of Excess Cost Aid for Students with Disabilities
1. TOTAL EXCESS COST AID (less Estimated or calc) $1,957,994.00
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 $3,267.00
6. December Gross Payment (Line 1 X .25 - tot St Sh Medicaid) $486,231.50
7. December Net Excess Cost Payment $486,231.50
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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