New York State Education Department                       
                         Office of Management Services                          
                                 State Aid Unit                                 
                                 (518) 474-2977                                 
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
      TREASURER                          District Code:    630801               
      HADLEY-LUZERNE CSD                 Municipal Code:   520744660100         
      PO BOX 200                         Date of Payment:  SEP 01, 2009         
      LAKE LUZERNE, NY  12846-0200       Amount of Payment:        $99,763.00   
                                                                                
                                                                                
     2008-09 Certificate of Excess Cost Aid for Students with Disabilities      
                                                                                
 1. TOTAL EXCESS COST AID (less Estimated or calc)         $1,348,386.00        
 2. Total Aug State Share Medicaid Amount                        $216.00        
 3. Total Sept State Share Medicaid Amount                     $2,872.50        
 4. Total Oct State Share Medicaid Amount                      $4,864.00        
 5. Total Nov State Share Medicaid Amount                      $4,025.50        
 6. December Gross Payment (Line 1 X .25 - tot St Sh Medicaid)      $325,118.50 
 7. December Net Excess Cost Payment                                $325,118.50 
                                                                                
 8. TOTAL EXCESS COST AID (less Estimated or calc)         $1,350,900.00        
 9. Total Dec State Share Medicaid Amount                      $4,623.00        
10. Total Jan State Share Medicaid Amount                     $13,746.00        
11. Total Feb State Share Medicaid Amount                      $7,584.00        
12. March Gross Payment (Line 8 x .70 - tot St Sh Medicaid & EC)    $582,580.50 
13. March Net Excess Cost Payment                                   $582,580.50 
                                                                                
14. TOTAL EXCESS COST AID (less Estimated or calc)         $1,350,900.00        
15. Total Mar State Share Medicaid Amount                     $13,664.50        
16. Total Apr State Share Medicaid Amount                     $15,507.99        
17. Total May State Share Medicaid Amount                      $3,046.26        
18. June Gross Payment (Line 14 x .85 - tot St Sh Medicaid & EC)    $170,416.25 
19. Less Adjustments for Therapeutic Foster Care                                
20. June Net Excess Cost Payment                                    $170,416.25 
                                                                                
23. TOTAL EXCESS COST AID (less Estimated or calc)         $1,350,900.00        
24. Total June State Share Medicaid Amount                    $10,419.47        
25. Total July State Share Medicaid Amount                    $10,923.04        
26. August Gross Payment (Line 23 - tot St Sh Medicaid & EC)        $181,292.49 
27. August Net Excess Cost Payment                                  $181,292.49 
                                                                                
28. TOTAL EXCESS COST AID                                  $1,450,663.00        
29. September Gross Payment (Line 28 - tot St Sh Medicaid & EC)      $99,763.00 
30. September Net Excess Cost Payment                                $99,763.00 
                                                                                
 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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