New York State Education Department
Office of Management Services
State Aid Unit
(518) 474-2977
TREASURER District Code: 211003
DOLGEVILLE CSD Municipal Code: 210750500200
38 SLAWSON ST Date of Payment: JUN 13, 2008
DOLGEVILLE, NY 13329-1298 Amount of Payment: $212,867.25
2007-08 Certificate of Excess Cost Aid for Students with Disabilities
1. TOTAL EXCESS COST AID (less Estimated or calc) $1,530,289.00
2. Total Aug State Share Medicaid Amount $13,225.00
3. Total Sept State Share Medicaid Amount
4. Total Oct State Share Medicaid Amount
5. Total Nov State Share Medicaid Amount
6. December Gross Payment (Line 1 X .25 - tot St Sh Medicaid) $369,347.25
7. December Net Excess Cost Payment $369,347.25
8. TOTAL EXCESS COST AID (less Estimated or calc) $1,531,936.00
9. Total Dec State Share Medicaid Amount
10. Total Jan State Share Medicaid Amount
11. Total Feb State Share Medicaid Amount
12. March Gross Payment (Line 8 x .70 - tot St Sh Medicaid & EC) $689,782.95
13. March Net Excess Cost Payment $689,782.95
14. TOTAL EXCESS COST AID (less Estimated or calc) $1,536,997.00
15. Total Mar State Share Medicaid Amount
16. Total Apr State Share Medicaid Amount
17. Total May State Share Medicaid Amount $21,225.00
18. June Gross Payment (Line 14 x .85 - tot St Sh Medicaid & EC) $212,867.25
19. Less Adjustments for Therapeutic Foster Care
20. June Net Excess Cost Payment $212,867.25
21. Est Accrued Aug Ex Cost (100% x Line 14 - St Sh Med & EC) $230,549.55
22. Est Accrued Sept Ex Cost (Actual - Estimated)
** The Estimated Aug Payment will be reduced by June and July St Sh Medicaid.
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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