New York State Education Department
Office of Management Services
State Aid Unit
(518) 474-2977
TREASURER District Code: 231301
BEAVER RIVER CSD Municipal Code: 230756800100
PO BOX 179 Date of Payment: Sept 2, 2008
BEAVER FALLS, NY 13305-0179 Amount of Payment: $43,277.00
2007-08 Certificate of Excess Cost Aid for Students with Disabilities
1. TOTAL EXCESS COST AID (less Estimated or calc) $432,272.00
2. Total Aug State Share Medicaid Amount
3. Total Sept State Share Medicaid Amount $7,632.50
4. Total Oct State Share Medicaid Amount $1,551.00
5. Total Nov State Share Medicaid Amount $1,144.50
6. December Gross Payment (Line 1 X .25 - tot St Sh Medicaid) $97,740.00
7. December Net Excess Cost Payment $97,740.00
8. TOTAL EXCESS COST AID (less Estimated or calc) $432,272.00
9. Total Dec State Share Medicaid Amount $917.50
10. Total Jan State Share Medicaid Amount $780.00
11. Total Feb State Share Medicaid Amount
12. March Gross Payment (Line 8 x .70 - tot St Sh Medicaid & EC) $192,824.90
13. March Net Excess Cost Payment $192,824.90
14. TOTAL EXCESS COST AID (less Estimated or calc) $432,272.00
15. Total Mar State Share Medicaid Amount $511.00
16. Total Apr State Share Medicaid Amount $18,389.00
17. Total May State Share Medicaid Amount $21,645.00
18. June Gross Payment (Line 14 x .85 - tot St Sh Medicaid & EC) $24,295.80
19. Less Adjustments for Therapeutic Foster Care
20. June Net Excess Cost Payment $24,295.80
23. TOTAL EXCESS COST AID (less Estimated or calc) $432,272.00
24. Total June State Share Medicaid Amount $6,792.50
25. Total July State Share Medicaid Amount
26. August Gross Payment (Line 23 - tot St Sh Medicaid & EC) $58,048.30
27. August Net Excess Cost Payment $58,048.30
28. TOTAL EXCESS COST AID $475,549.00
29. September Gross Payment (Line 28 - tot St Sh Medicaid & EC) $43,277.00
30. September Net Excess Cost Payment $43,277.00
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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