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Office of the State Auditor <br />City Financial Reporting Form <br />Cities Reporting Using the Cash Basis of Accounting <br />VpITpR CUENTS CO" <br />.�DILE DUM �. <br />O I � • <br />Government Information Division <br />525 Park Street, Suite 500 <br />Saint Paul, Minnesota 55103 <br />Phone: (651) 282-6114/Fax: (651) 282-2391 <br />E-mail: gid@osa state mn.us <br />Web site: www.auditor.state.mn.us <br />City of- Gem Lake <br />For the Year Ended December 31, 2004 <br />Please complete this form per Minn. Stat. Sec. 6.74 <br />and return it with the city's financial statement by March 31st . <br />NOTE: THIS FORM SHOULD AGREE WITH THE FINANCIAL STATEMENT TOTALS. <br />This report has been prepared from the records of the city and includes, to the best of my knowledge, all transactions for all funds of the city for the year ended December 31, 2004. <br />lndwmo dole, (AMVUIUItNIN,WCa) <br />0 **Please check if the duties of clerk and treasurer are combined per Minn. Stat 412.591 Subd. 2. if.hangv m <br />lulus during 2004: <br />Name Phone# E-mail Address <br />City Clerk: <br />Frederic C. Magnuson (651) 426-6443 aemlakecitv�aol.com <br />Clerk's Signature: <br />Date: <br />Do total revenues of all runds of the No <br />Treasurer: <br />Sarah B. Cobian (651) 426-6443 citye:cecd Sl5o,000? Checkonc. --Yes <br />x <br />Mayor: <br />Paul R. Emeott (651) 426-6040 <br />Signature of <br />Mayor or Treasurer*: Date: <br />Council <br />Audit Firm: <br />N/A <br />Audit Firm Contact: <br />Expected Date to Complete Audit: <br />Please check <br />if change of address. <br />City Phone# City E-mail Address <br />City Mailing <br />1369 County Road E East (651) 426-6443 aemlakecflygk ol.corn <br />Address: <br />Gem Lake, MN 55110-5231 City Fax# <br />(651) 426-6444 <br />* The mayor or the treasurers signature is required <br />"* <br />Per Minn Stat 412 591 Subd 2, your city is required to have an audit if the duties of clerk and treasurer are combined and total revenue of all city funds exceed $150,000 <br />If revenues do not exceed $ 150,000, your city is required to have an audit once within every five-year period <br />