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:  SEP 01, 2009         
      DOLGEVILLE, NY  13329-1298         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)         $1,543,395.00        
 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                                       
 6. December Gross Payment (Line 1 X .25 - tot St Sh Medicaid)      $385,848.75 
 7. December Net Excess Cost Payment                                $385,848.75 
                                                                                
 8. TOTAL EXCESS COST AID (less Estimated or calc)         $1,543,395.00        
 9. Total Dec State Share Medicaid Amount                                       
10. Total Jan State Share Medicaid Amount                      $4,374.00        
11. Total Feb State Share Medicaid Amount                      $5,757.50        
12. March Gross Payment (Line 8 x .70 - tot St Sh Medicaid & EC)    $684,396.25 
13. March Net Excess Cost Payment                                   $684,396.25 
                                                                                
14. TOTAL EXCESS COST AID (less Estimated or calc)         $1,639,729.00        
15. Total Mar State Share Medicaid Amount                                       
16. Total Apr State Share Medicaid Amount                      $6,210.40        
17. Total May State Share Medicaid Amount                      $1,234.91        
18. June Gross Payment (Line 14 x .85 - tot St Sh Medicaid & EC)    $305,947.84 
19. Less Adjustments for Therapeutic Foster Care                                
20. June Net Excess Cost Payment                                    $305,947.84 
                                                                                
23. TOTAL EXCESS COST AID (less Estimated or calc)         $1,639,729.00        
24. Total June State Share Medicaid Amount                                      
25. Total July State Share Medicaid Amount                    $15,384.36        
26. August Gross Payment (Line 23 - tot St Sh Medicaid & EC)        $230,574.99 
27. August Net Excess Cost Payment                                  $230,574.99 
                                                                                
28. TOTAL EXCESS COST AID                                  $1,639,729.00        
29. September Gross Payment (Line 28 - tot St Sh Medicaid & EC)                 
30. September Net Excess Cost Payment                                           
                                                                                
 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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