New York State Education Department                       
                         Office of Management Services                          
                                 State Aid Unit                                 
                                 (518) 474-2977                                 
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
      TREASURER                          District Code:    540901               
      JEFFERSON CSD                      Municipal Code:   430742800100         
      MAIN ST RR2 BOX 101                Date of Payment:  SEP 01, 2009         
      JEFFERSON, NY  12093-0039          Amount of Payment:         $1,578.00   
                                                                                
                                                                                
     2008-09 Certificate of Excess Cost Aid for Students with Disabilities      
                                                                                
 1. TOTAL EXCESS COST AID (less Estimated or calc)           $417,781.00        
 2. Total Aug State Share Medicaid Amount                                       
 3. Total Sept State Share Medicaid Amount                     $1,501.00        
 4. Total Oct State Share Medicaid Amount                                       
 5. Total Nov State Share Medicaid Amount                        $215.00        
 6. December Gross Payment (Line 1 X .25 - tot St Sh Medicaid)      $102,729.25 
 7. December Net Excess Cost Payment                                $102,729.25 
                                                                                
 8. TOTAL EXCESS COST AID (less Estimated or calc)           $479,962.00        
 9. Total Dec State Share Medicaid Amount                        $422.00        
10. Total Jan State Share Medicaid Amount                                       
11. Total Feb State Share Medicaid Amount                        $852.00        
12. March Gross Payment (Line 8 x .70 - tot St Sh Medicaid & EC)    $230,254.15 
13. March Net Excess Cost Payment                                   $230,254.15 
                                                                                
14. TOTAL EXCESS COST AID (less Estimated or calc)           $479,962.00        
15. Total Mar State Share Medicaid Amount                        $422.00        
16. Total Apr State Share Medicaid Amount                                       
17. Total May State Share Medicaid Amount                                       
18. June Gross Payment (Line 14 x .85 - tot St Sh Medicaid & EC)     $71,572.30 
19. Less Adjustments for Therapeutic Foster Care                                
20. June Net Excess Cost Payment                                     $71,572.30 
                                                                                
23. TOTAL EXCESS COST AID (less Estimated or calc)           $479,962.00        
24. Total June State Share Medicaid Amount                     $1,359.91        
25. Total July State Share Medicaid Amount                                      
26. August Gross Payment (Line 23 - tot St Sh Medicaid & EC)         $70,634.39 
27. August Net Excess Cost Payment                                   $70,634.39 
                                                                                
28. TOTAL EXCESS COST AID                                    $481,540.00        
29. September Gross Payment (Line 28 - tot St Sh Medicaid & EC)       $1,578.00 
30. September Net Excess Cost Payment                                 $1,578.00 
                                                                                
 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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