New York State Education Department                       
                         Office of Management Services                          
                                 State Aid Unit                                 
                                 (518) 474-2977                                 
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
      TREASURER                          District Code:    200901               
      WELLS CSD                          Municipal Code:   200788600100         
      PO BOX 300                         Date of Payment:  SEP 01, 2009         
      WELLS, NY  12190-0300              Amount of Payment:             $0.00   
                                                                                
                                                                                
     2008-09 Certificate of Excess Cost Aid for Students with Disabilities      
                                                                                
 1. TOTAL EXCESS COST AID (less Estimated or calc)           $100,266.00        
 2. Total Aug State Share Medicaid Amount                                       
 3. Total Sept State Share Medicaid Amount                                      
 4. Total Oct State Share Medicaid Amount                      $4,915.08        
 5. Total Nov State Share Medicaid Amount                      $9,114.59        
 6. December Gross Payment (Line 1 X .25 - tot St Sh Medicaid)       $11,036.83 
 7. December Net Excess Cost Payment                                 $11,036.83 
                                                                                
 8. TOTAL EXCESS COST AID (less Estimated or calc)           $100,266.00        
 9. Total Dec State Share Medicaid Amount                                       
10. Total Jan State Share Medicaid Amount                      $4,488.65        
11. Total Feb State Share Medicaid Amount                      $3,567.21        
12. March Gross Payment (Line 8 x .70 - tot St Sh Medicaid & EC)     $37,063.84 
13. March Net Excess Cost Payment                                    $37,063.84 
                                                                                
14. TOTAL EXCESS COST AID (less Estimated or calc)           $103,954.00        
15. Total Mar State Share Medicaid Amount                        $432.00        
16. Total Apr State Share Medicaid Amount                      $2,379.61        
17. Total May State Share Medicaid Amount                        $277.48        
18. June Gross Payment (Line 14 x .85 - tot St Sh Medicaid & EC)     $15,085.61 
19. Less Adjustments for Therapeutic Foster Care                                
20. June Net Excess Cost Payment                                     $15,085.61 
                                                                                
23. TOTAL EXCESS COST AID (less Estimated or calc)           $103,954.00        
24. Total June State Share Medicaid Amount                     $2,579.56        
25. Total July State Share Medicaid Amount                     $2,363.97        
26. August Gross Payment (Line 23 - tot St Sh Medicaid & EC)         $10,649.57 
27. August Net Excess Cost Payment                                   $10,649.57 
                                                                                
28. TOTAL EXCESS COST AID                                    $103,954.00        
29. September Gross Payment (Line 28 - tot St Sh Medicaid & EC)                 
30. September Net Excess Cost Payment                                           
                                                                                
 Check will be mailed under separate cover from the Division of the Treasury.   
 (ST-3 Code A3101 Basic Formula Aid - Excess Cost Only)                         
                                                                                
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