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HomeMy WebLinkAbout2000 12 11 Regular D Additional Equipment and Software for Finance COMMISSION AGENDA ITEM[ D CONSENT INFORMATIONAL PUBLIC HEARING REGULAR x Meeting MGRM /DEPT ~ Auth'orization December ][1, 2000 REQUEST: The Finance Department requests the City Commission authorize appropriations from General Fund and Water & Sewer fund balance $39,857 and $35,840 respectively, to purchase Finance, Utility Finance, Purchasing and Business License equipment and software that will enhance the capability of tine new Financial Management Data Processing System. And waive the competitive bidding requirements due to sole source providers. PURPOSE: The purpose ofthis agenda item is to request the City Commission authorize the City's purchase of additional equipment and software for the Finance, Utility Finance, Purchasing and Business License Departments to enhance the new Financial Management Data Processing System. CONSIDERATIONS: Opportunities exist to enhance the efficiency and effectiveness of the new Munis Financial Management Data Processing System. The Finance Director, City Controller (Accounting Manager) and Data Processing M.mager have identified several improvements that will greatly enhance the overall efficiency and effectiveness of the new Munis Financial Management Data Processing System and result in the efficiency and effectiveness ofthe City's various Departments as a whole. There are three categories of equipment and software below that the Finance Department is requesting for these enhancements. Had the current personnel been in place at the time our City's computer needs were identified and then bid out, these requests would probably already have been included as a part of the total cost of the computer conversion. The Departments approach is to implement available time saving technology whenever the benefits outweigh the costs both quantitative and qualitative. . The first category is a "Must Have" that includes the Micro Encoder, one Cashier System and license fees. The Micro Encoder will simply pay for itself as evidenced in the discussion below. The Cashier System is necessary to operate the front desk and was inadvertently left off of the list of items needed to facilitate the computer conversion. In addition, monies were left out of the RFP for the Oracle License Fee and the Unix License fee for the extra processor. . The second category is a "Should Have" that includes the second Cashier System for the benefit of our customers and balancing the drawers. This category includes laser software called "FORMUNIS". This is a fonns software made specifically for Munis. Unfortunately, this was not included in the total cost of the computer conversion. See separate packet for benefits associated with the use of forms software. This category also includes three laser printers, three signature cards and printer warranties. The laser printers will allow us to utilize the forms software, place bar coding or OCR's on our utility bills which then allows us to scan payments into the Ireceipting system, as well as allow us to utilize the banks lockbox system. In addition, use of laser printers will allow us to utilize the postal software, which then qualifies us for a postal discount, which we estimate, will save $10,000 annually. . The third category is a "Would Be Nice To Have" that includes a smaller laser printer for the payroll office that would provide a level of confidentiality regarding payroll and payroll related transactions and repOlts that currently does not exist. In addition, the payroll office is not conveniently located to the current printer housed in the Accounts Payable Department. This category also includes an inventory-tracking system that would allow us to barcode the City's assets and then scan them for inventory purposes removing the element of human nature and error. The following represents a description of the equipment/software, the advantages we feel the equipment/software will provide to the Departments, a description of our current procedures and an estimated cost and required implementation date: MICRO ENCODER A Micro encoder is a piece of equipment that uses special ink to encode (imprint) the check amount on the bottom of the check and endorse the back of the check automatically. The machine runs a tape while it is encoding and automatically adds up the checks. The tape can be used in lieu of a deposit slip. We currently hand add all checks two times, then we manually hand stamp the back of each arid every check for deposit. Advantages of the Micro Encoder: .:. We receive approximately 13,000 checks a month (mainly utility). A Micro encoder will decrease the length of time it takes for front desk staff to prepare the checks for deposit - adding machine tapes, endorsing and deposit slip preparation. Front desk staff time could be used in other needed areas. .:. We currently pay .11 cents per check in bank processing fees, encoded checks cost .045 cents in bank processing fees for checks drawn on "Bank of America accounts", .055 cents for "local clearinghouses", .07 cents for "in district" and .09 cents for "all others". At an averaged of .065 cents results in an estimated annual savings of $7,020 in bank processing fees. Estimated cost for the encoder $8,500 Vendor is NCR Use of the Micro encoder could be implemented as soon as possible. Within one years time frame it will have practically paid for itselfin reduced bank fees. CASHIER SYSTEMS The cashier system is a set of equipment that includes: . a cash drawer that plugs into the PC the Cashier uses, . a receipt printer to print customer receipts, and . an optical reader that will read either bar code or OCR scan lines to scan the payments into the computer (note that we must place the bar code or OCR on the utility bill - see laser printer request). The system will allow staff to provide faster customer service to the public as well as reduce the amount of time spent hand-keying payments into our computer software - we receive approximately 13,000 payments a month. In addition, the system will improve accuracy in the posting of payments and the timeliness of our deposits. We are currently hand keying payments received over the counter into an independent cash register and then we hand key the payments into the billing system and then staff turns around and prepares a spreadsheet so that we may then enter the transactions into the accounting system, Additionally, we only have one cash drawer at the front desk but we have two front desk personnel. Customer lines form while our two front desk personnel wait to use the one register. The register currently must be balanced during non-business hours otherwise our customers would have to wait until we balance to make their payments at the front desk. The current system is fraught with inefficiencies both in front of and behind the scenes. Our current Cashier System can not be integrated with our new software. It was inadvertently left off ofthe computer conversion package price. Advantages associated with the purchase ofDYQ Cashier Systems: .:. Two Cashier Systems will allow us to process with two independent drawers making each cashier responsible for balancing their drawer/deposit. .:. Two Cashier Systems will allow us to balance the drawers during work hours so that the deposit can go to the bank the same day rather than the next day. .:. Two Cashier Systems will allow us to wait on two customers at the same time reducing the time our customers wait in line. .:. A Cashier System will allow us to scan payments for greater accuracy and speed versus hand keying into the billing system. See laser printer and software section for bar coding. .:. A Cashier System will allow us to interface the posting of payments to the posting of the general ledger. .:. A Cashier System will allow IllS to go to the lock box form of payment. See laser printer and software section for bar coding. Lock box payments are sent directly to the bank by the customer and the bar code of lthe bill is scanned, the bank then sends us an interface file that we upload in order to post payments in batch form. .:. A Cashier System will allow the acceptance of credit cards right on the cash receipt system. We would still need the credit card machinery from the banle .:. A Cashier System will allow us to deposit our cash quicker. Estimated Cost for a two drawer system set up $8,000 or $4,000 each Vendor is Munis which will provide an Ithaca printer, Indiana cash drawer and Caere scanning equipment. The front desk portion of the computer conversion is due to go live June 1,2001. Cashier System (s) will need to be in place by that time. At least one must be purchased. LICENSES This category includes a $4,800 Oracle license fee and a $1,000 Unix License fee for the extra processor. These items were inadvertently left off of the cost of the computer conversion. Estimated Cost $5,800 PRINTERS AND SOFTWARE This group of requests consist of: . Four laser printers (one in Payroll, one in Accounts Payable ,one in Utility Billing and one in Purchasing) . Four PCMCIA signature modules (two in Finance, one in Purchasing and one in Business Licenses) . An extended warranty on thl~ printers, . Laser solutions software "FORMUNIS" (Specifically forms for Munis - unfortunately not previously added into our computer conversion bid package including forms for Business Licenses) and . Postal software The laser printers (one in the Payroll office and one in the Accounts Payable office) will allow us to print and sign both our payroll and our AP checks on a secured and controlled blank stock. The Utility Billing printer would print both sides of the utility bill and allow for payment scanning and lock box processing, as we would be able to print the bar code on the bill.. One printer in Purchasing will allow us to replace the current one with a form compatible medium. Laser solutions software will save in printing costs as the canned forms now used for check stock, purchase orders, and utility bills are more expensive than purchasing blank stock. Use of blank stock for the utility bills alone will provide us with an estimated net annual savings of $2,300/year. Use of the software and laser printers will allow us to have one check stock for all bank accounts, as it will print the account number on the check at the time of printing. This allows us to have blank check stoek instead of checks for every account and the signature cards would eliminate the separate step of signing the checks on the check-signing machine. The postal software will allow us to get the maximum savings discount from the post office by allowing us to "CASS certify" ow: mailings. The new base computer program we purchased does not allow for any postal discounting. We currently have two Genicom dot matrix printers - one in Accounts Payable and one in Utility Billing. The dot matrix printers c:annot place bar coding on the utility bills. Two lasers would be needed to replace the two Genicom dot matrix printers. The request for the additional smaller printer in Payroll is to achieve some level of privacy regarding sensitive payroll and payroll related material. The Munis software is not able to print forms or checks from blank stock; hence, the request for the Laser solutions software. We currently pay the highest bulk rate available at the post office. Advantages of purchasing the printers and software: .:. The postal software will allow for a major postage discount savings of $1 0,000 annually .:. The laser solutions software and the laser printers allow for use of blank stock over the more expensive preprinted stock .:. Use of blank check stock and the Accounts Payable and Payroll laser printers allow for greater check security reducing the risk of fraud .:. The laser solutions software and the laser printers allow for a more efficient use of time and reduce the amount of paper shuffled around. .:. The laser printer in Payroll allow for greater security of confidential payroll transactions .:. The Accounts Payable and Utility Billing laser printers allow for use of the OCR scanning technology and lock box processing Estimated cost of three printers (two big one little), signature card & warranty Estimated cost of purchasing laser printer & signature module Estimated cost of Finance laser software Estimated cost of Business License software and forms Estimated cost of postal software $13,000 $ 3,361 $17,300 $ 3,300 $ 5,190 The printers and the warranty would be purchased using State contract prices - we would buy from anyone who sells using State contract prices. The signature card in from the vendor named Jetforms who provides the FORMUNIS software. The vendor for the laser software and the postal software is Jetforms (who provides the product FORMUNIS). Jetforms is a separate company from MUNIS; however, they are considered a business partner and they are a sole source provider of integrated foml and postal technology for MUNIS. The printers and software need to be in place for a March I sl implementation. INVENTORY TRACKING SOFTWARE/INTERFACE The independent tracking software and interface is a system that will allow us to track fixed asset inventory. It would allow us to track, tag, and inventory our fixed assets utilizing a bar code scanner and printer. The system would give us better control over our assets. Each asset would be labeled with a bar code that would be entered and scanned into the scanner. It would then be interfaced with the Munis software and tracked for CAFR reporting purposes. At year end when we do our required inventory, the scanner would be used to scan in all our assets eliminating the manual paper tracking. Additionally, the system will allow for tracking under the new GASB 34 rules. We currently manually enter and tag each asset onto a card (filled out by hand) and then re-enter the information into the asset inventory software where it is tracked and if needed depreciated. Then we generate an inventory listing and manually account on that paper for the assets. Then we update the computer system aecordingly as well as updating the paper assets cards. Cumbersome and inefficient. Advantages to bar coding and tracking our fixed asset inventory: .:. Reduces the amount of time spent hand counting and tabulating the assets from all departments .:. Allows us to comply with GASB 34 requirements .:. Allows us to better track the City assets .:. Provides for a seamless integration to the Munis fixed asset accounting system .:. Eliminates the manual proces:; of updating the asset system from the paper card system Estimated cost of the equipment Estimated cost of interface/training $6,000 $4,000 Vendor for the software is BMI and they are a sole source provider of integrated fixed asset technology with MUNIS. The interface would be purchased from MUNIS. Fixed assets to go live on March :[ st. If approved would need in place prior to that date. OTHER CONSIDERATIONS: . Projected FY 2001 ending General Fund fund balance at $2,345,811. Projected FY 2001 ending Water & Sewer Operating fund balance at $1,581,798. . To date our commitment to MUNIS for the computer conversion per the purchase order is $634,914. In addition there are ancillary costs associated with this project for such things as the project manager from Ameritek hired to identify our overall needs and evaluate the vendors proposing. FUNDING: The total package I'm recommending costs $74,451. I felt based on the dual nature of most of the items detailed that the Enterprise Fund should pay for $35,840 of the purchases (via a transfer to Finance Utility Billing) and the: General Fund should pay for the remaining $38,611as an appropriation from fund balance. Where equipment/software was projected to be used by both departments I split 50/50 to detennine cost allocable to each of the funds. Detail follows: Total Utility Fund General Fund "Must Haves" Micro Encoder $8,500 $8,500 $0 One Cashier System $4,000 $2,000 $2,000 Licenses $5.800 $0 $5.800 $18,300 $10,500 $7,800 "Should Haves" Second Cashier System $4,000 $2,000 $2,000 Two laser printers, sign card, warranty $9,000 $4,500 $4,500 Laser Solutions Software $17,300 $8,650 $8,650 Postal Software $ 5,190 $5,190 $0 Laser printer for purch, sign mod & waIT $3,361 $0 $3,361 Business License sign module & forms $3.300 $0 $3.300 $42,151 $20,340 $21,811 "Be Nice to Have" Third laser printer for Payroll $ 4,000 $0 $4,000 Inventory Tracking software $ 10.000 $5.000 $5.000 $14,000 $5,000 $9,000 Total $74.451 $35.840 $38.611 RECOMMENDATION: The Finance Department recommends the Commission authorize supplemental appropriations from the General Fund in the amount of$38,611 and supplemental appropriations from the Utility Fund in the amount of $35,840 to fund the above referenced enhancements to the Munis Financial Management Data Proc.essing, streamline the inefficiencies in the Finance, Finance Utility, Purchasing and Business ]Licenses Departments, and more fully realize the benefits associated with the impending computer conversion. It is also recommended that the Commission waive competitive bidding on the Jetforms laser software which is a sole source provider and which exceeds the $12,500 contract limit. .. IMPLEMENTATION SCHEDULE: Micro Encoder Cashier Systems Printers & Software Inventory Tracking Software ASAP June 1,2001 March 1, 2001 March 1,2001 ATTACHMENTS: Site Plan for Installation of Forms, Software Estimated Cost Sheet for Forms Software and Postal Software Laser Form Information Package COMMISSION ACTION: , I ~ FOR M U N I 5 ,. CITY OF WINTER SPRINGS, F1L Estimated Costs for Installation November 17, 2000 Page One Z -.../::: I -, 3 c::::> , etForm Central Pro™ Software Limited license restricted to output from the MUNIS application software only. Includes Munis integration and supporting software. $ 4,500.00 ./ .. FORMUNIS Standard Forms Library 3,000.00 ,/ Package included nine standard forms: accounts payable checks. payroII check, direct deposit notification, purchase order, W-2. I099M, I099R accounts receivable statement and accounts receivable invoice. Also included is one logo or seal. Custom modifications to any standard (orm will result in additional costs to be quoted after review of the modification. Additional Accounts Payable Check - Enterprise Fund 500.00 J 800.00/ Custom Utility Bill (Estimated) Actual cost to be billed upon completion o( design, ./ 2,500.00 Custom FORMUNIS Support (1 year) Installation - Three Days 4,500.00 /. / ($1.500.00 per day) V Travel Expenses (Estimated) 1,500.00 Estimated costs (or travel (air or vehicle), hotel accommodations, meals and expenses to travel to your location. Aclual sts incurred to be billed upon completion o(your instaIIation. \;0-' Postal Software 2,995.00 ~\'\o h<~ Postal Software Extended Service Plan Includes destination delivery update every 6 (six) months. 2,195.00 ~... x:[PCMCIA Check Signing System $ 1,500.00 > c- ''':'_\-'4XJ ,-"~ Freight for the PCMCIA Check Signing System 50.00 @ .-" '-<>~ v'" _..c.. r"'-~J Additional PCMCIA Signature Card Mo Includes the same two signatures as original card. Additional signatures can be purchased at a cost~.OO each. ~[j[] B~ ~ FORMUNJS.. FORMUNIS Product and Services Descriptions FORMUNIS Software Package $ 4,500.00 FORMUNIS software package includes output management system for laser printing, GUI (graphic user interface) for printer control. printer set-up for tray selections, seamless integration with the MUNIS software program, remote support software and configuration and message control. Based on the special pricing exclusive to MUNIS customers (for the JetForm Central Pro software program used for our solution, JetForm Corporation restricts the license), the license is restricted to print applications from the MUNIS software program only, If output functionality is desired from application(s) other than MUNIS, a full license must be purchased, FORMUNIS Standard Forms Library $ 3,000.00 Includes ten standard forms: payroll check. direct deposit notification, accounts payable check. purchase order, W-2, W-2C, 1099M, 1099R. invoice and statement. There are two check styles to choose from: check on top (fold and insert) or pressure seal (check in the middle). Package includes one logo, two digitized signatures, MICR font Postnet font and start and stop pages, Forms sold individually at $500,00 per form. Custom modifications to any standard form will result in additional costs to be quoted after review of the modification. FORMUNIS Custom Designs Custom designs tan be created for any application printing from the MUNIS software program are available, These forms are priced on an individual basis and pricing will be supplied once the sample form and data have been reviewed. Every form can be unique. forms output the way you want it! Page two. rev (11/00) 0 " ' ~ FORMUNJS.. FORMUNIS Product and Services Descriptions Installation $ 3,000.00 The daily rate for installation is $' .500,00 per day plus travel expenses, Our installation and training will encompass two days and includes several hours of pre-installation, FORMUNIS will begin the installation by installing all the software, forms and job management on the server, On site training and testing is included in the installation fee, We will want al! users and technical staff present for this instruction, FORMUNIS will review all aspects of the printer and forms applications, as well as the specific instructions for all the components involved in our installation. We will review what happens when jams occur and how to reprint any form.- Our personnel will also advise system users of the security issues that need to be considered when processing checks, We will install and include in our training the procedures for utilizing the PCMCIA signature cards. Additionally, we will train the users on all equipment purchased and how to operate it for each individual application, Travel Expenses (Estimated) $ 1,000.00 The actual costs incurred to travel to your location for the installation, Travel expenses include air and/or vehicle costs to your location, car rental, hotel accommodations, meals and expenses associated with traveling to your location. FORMUNIS Support Plans Support. Maintenance and Consulting $ 1,500.00 The responsibility for the success of your print and output using the JetForm Central Pro software (for tt)e limited license application) has been transferred from JetForm@ Corporation to FORMUNIS. FORMUNIS support is a recommended purchase to support your installation. FORMUNIS will provide technical support for the components of the FORMUNIS software package, (including JetForm Central Pro™ software) the form designs along with providing consulting for future development. JetForm Corporation will not support the components associated with this installation for the limited license application. Design Support $ gO.OO/Event FORMUNIS provides design services for modifications to the installed designs. This service is for revisions or modifications required by the customer as a result of form design changes that take place (in the normal course of business) after the installation, Page three . rev (11/00) 0 '. .. ~ .FORMUNIS', FORMUNIS Process Choices Postal Software FORMUNIS Postal Software for Laser to Mail $ 2,995.00 This software allows you to be confiejent that you have the highest quality addresses, mail presorting and business documents possible. Address correction, mail presorting. and address output solutions provided by this software meet or exceed rigorous industry standards. By using this software. 'you receive the greatest postal savings clvailable through CASS and PAVE certification, FORMUNIS Postal Software Training $ 1,500.00 One day of additional on-site traininq is required to review the postal instructions and the process of using the postal certified software. We will teach those involved what needs to be done when preparing and processing the mail forthepostoffice.This will include the use of service request endorsements, how to ensure the lowest possible postal rate, metering mail. traying the mail. and working with you postal bulk processing center. Extended Service Plan for FORMIUNIS Postal Software. Annual Fee $ 2,195.00 The purchase of this support package entitles you to national destimation delivery address updates every six months. Optimize Postal Savings with our Address Corr,ection and Sorting Module Our easy to use module meets all U.S postal service mailing regulations to give you maximum postage discounts and fast delivery of your mail. . Save time on mail preparation and increase your response rates. . Complete Database Management . Merge/Purge Tools . Easy to use with Windows Design and "wizards). Page five ,rev (11/00) D ~ FORMUNIS.. FORMUNIS COlltrolJed Check Stock Security Features FOf~MUNIS Controlled Check Stock meets or exceeds the ANSI (American National Standards Institute) paper specifications for checks. This stock is stored at FORMUNIS in our on site secure storage facility and handled exclusively by FORMUNIS personnel. A controlled numbering system is used to track our check stock as it arrives and departs our facility. These security features are standard on both our pressure seal and our laser cut sheet check stock, FORMUNIS's controlled check stock offers the following enhanced security features to help deter fraudulent activity: Controlled Check Stock Paper Security Features . UV Dull Ultra Violet 25# Paper This paper has most of the flouresence removed, This feature is desirable because it allows the flourescent ink used in the artificial watermark and the invisible flourescent fibers in the stock to glow more brightly and be more easily checked by your financial institution. The paper used in our controlled check stock is not sold in office supply stores and is not readily available to forgers. . TonerFusefM Coated Paper This unique surface treatment is a mill applied coating that allows the stock to grip or grasp laser printer toner better than traditional paper, As a result, it makes it difficult for forgers to remove the toner to change information, Any alteration attempts become clearly detectable, . Chemical Sensitivity GBF's stock is treated to react with chemicals that a forger would use to erase text on the check and replace it with fraudulent information. Our stock is treated to react with high polarity solvents, low polarity solvents and oxidants which are commonly used by forgers, Controlled Check Stock Pre-Prinwd Security Features . Void Pantograph Our pantograph (check background) contains the word "VOID" which is exposed when a forger tries to use a photocopier to duplicate a check. . Border Copy Warning A notice or warning is present on the check and is designed to advise document handlers and potential forgers of specific overt and covert safeguards present. Page seven - rev (11/00) D .~. FORMUNJS.. FORMUNIS COJrltrolled Check Stock Security Features . Micro Printed Regulation CC Backer This is a standardized area located on the back of checks intended to provide uniformity of endorsement process for expeditious return of check to the issuer, Our backer contains micro.printing in the copy as a,n additional measure of security, . Artificial Custom Watermark An image on the back of the check which is visible when the stock is held at an angle. This feature cannot be replicated by desk top printers and is an overt featured readily identifiable by legitimate document handlers. . Control Numbers Our stock features a preprinted control number which is tracked in our faciltiy upon arrival and departure, It also allows you to use the control numbers for tracking at your own site. Controlled Check Stock laser Printed Security Features . Micro-Print Signature Line The signature line printed through FORMUNIS contains the name of your organization in extremely small type that is not reproducable by a photocopier or most standard software products used by forgers, . Micro-Print Symbol The symbol that appears after the signature line is an overt security feature that alerts document handlers to examine the signature line for micro-printing. Page eigtlt . rev (11/00) 0 I j I j j i ! I j i I i ! I i I j ; j j ! I A FORMUNIS. Optimize 1~P.lII~1 Postal Savings B IM~I with our Address Correction and Sorting Module Our easy to tJlse module me-ets all u.s. postal service mailing regulations to give you maximum postage discounts and fast delivery of your mail. . Save time on mail preparation and increase your response rates. . Complete Database Management Merge/Purge Tools Easy to use with Windows Design and .wizards. Increase ,jlddress accuracy and speed delivery of your mailings with CASS-certlfied (Coding Accuracy Support System) address-assignment that lets you: . Add Zip+4; Codes. carriE.'r route codes. and POSTNET delivery-point barcodes on mail pieces, . Prepare your files for NCOA (National Change of Addreu) pro<es~ng. . Create and print an ACS (Address Change Servke) keyline. . Find dupll(ates to eliminate unnecessary postage and printing costs. Save prel:.aration time and money on postage with PAVE-certified (Presort Accuracy, Validation, and Evaluation) presorting capabilities that: . Presorts mail to meet USPS regulations. . Perform up to four presort schemes In one pass. . Support walk-sequence file information. . Merge multiple mailings for even greater savings. . Print complete. ready to sign USPS mailing statements. Forms Output the Way You Want It fI1B CASS CERTIFYI NG PAVE PRESORTING [lJ I I I I I I I I I I I I ! . \ A FORMUNIS.. CITY OF WINTER SPRINGS, FL Site Plan for Installation November 17, 2000 CITY OF WINTER SPRINGS, FL Project Manager Rita Hartman Phone 407 -327 -5954 407-327-4753 Fax Email rhartman@winterspringsfl.org Pre- Installation FORMUNIS is relying on the accuracy of the information provided to create a successful install for print output. FORMUNIS will create the laser output system design in advance of our site installation. Our installation schedule does not allow time for more than a few minor modifications. All modifications are billable and may require us to return to your site at your expense. Scope The live date for the accounts payable checks and purchase order is March 1, 2001. The live date for the payroll check and direct deposit is April 1, 2001. The live date for utility billing is June 1. 2001. JetForm will be installed and processing the MUNIS application data to designated printer(s). The forms will be personalized with organizational identity and printed as specifically designed. Platform Windows NT Printer(s) HP 8lO00N HP 4050TN ~[8] B~ ,~ FORMUNIS- m[]i] Or:A1 c=J~ SITE PLAl'v FOR INSTALLATION CITY OF I~INTER SPRINGS, FL NO~'EMBER 17, 2000 ...ili,lr,,~ \," L o!I .:: r.()I~.~.~,~lft -:. .~, ,0 ~g.."",~:~ of I ,~ .\ 'Jr A'l~"" ,:~.":...........,f ..'~.~~ .;. I'\~n""""""'" ~t~r~~:~ 0' '~:'I>~\? ~t.~... .,;~" <=-. ,I:, ';.~ ' .1.. A FORMUNI5~ CITY OF WINTER SPRINGS, FL Site Plan for Installation November 11, 2000 Form User Applications: Contact Person: Live Date: Accounts Payable Check - General Fund Rita Hartman March I. 200 I Project Scope · Application Description Laser prints account payable check with signature, MICR and Arabic numbers. FORMUNIS has received a sample of your check. The content of this form has been reviewed based on the spool data from MUNIS. The MUNIS form field names and form content will match. FORMUNIS will make changes to the organizational identity and bank information after reviewing the current check. A "tiff' electronic file of your s,eal or organizational identity is required if this is going to be added to the design of your accounts payable check. Form Output Description Application Part(s) Printer Input tray(s) Output tray(s) Signatures Stock Accounts Payable 2 HP 8100 ON 2, 2 I. 1 2 Green Laser Cut Sheet Check Stock When numbering your checks, how many digits will be used for the check number? _ Please note: Financial Institutions require a minimum of6 digits. (Number beginning 100,001 or more) FORMUNIS requires that each of the form installations outlined within the site plan be reviewed for their accuracy based on the information outlined. A signature indicates the acceptance of and agreement to the information defined within the form application. Modifications from the original specifications will be documented and are a chargeable service that will be billed at $90.00 per change/modification. Signature Date This sheet must be signed and received (prior to the installation). Please return via fax transmission to Joanne Lord at 207-774-0607. Thank you. ~[1U IW(a<mII~~~1 A FORMUNIS.. CITY OF WINTER SPRINGS, FL Site Plan for Installation November 17, 2000 Form User Applications: Contact Person: Live Date: Accounts Payable Check - Enterprise Fund Rita Hartman March I. 200 I Project Scope · Application Descrill)tion Laser prints account payable check with signature. MICR and Arabic numbers. FORMUNIS has received a sample of your check. The content of this form has been reviewed based on the spool data from MUNIS, The MUNIS form field names and form content will match. FORMUNIS will make changes to the organizational identity and bank information after reviewing the current check. A "tiff' electronic file of your seal or organizational identity is required if this is going to be added to the design of your accounts payable check. Form Output Description Application Part(s) Printer Input tray(s) Output tray(s) Signatures Stock Accounts Payable - Enterprise Fund 2 HP 8100 ON 2. 2 1. 1 2 Green Laser Cut Sheet Check Stock When numbering your checks, how many digits will be used for the check number? - Plcasc notc: Financial Institutions rcquirc a minimum of6 digits. (Number beginning 100,001 or more). FORMUNIS requires that each of the form installations outlined within the site plan be review~d for their accuracy based on the information outlined. A signature indicates the acceptance of and agreement to the information defined within the form application. Modifications from the original specifications will be documented and are a chargeable service that will be billed at $90.00 per change/modification. Signature Date This sheet must be signed and received (prior to the installation). Please return via fax transmission to Joanne Lord at 207-774-0607. Thank you. ~[jJ EJ~ A FORMUNIS.. CITY OF WINTER SPRINGS, FL Site Plan for Installation November 17, 2000 Form User Application: Contact Person: Live Date: PayroIl Check Rita Hartman April 1, 2001 Project Scope · Application Description Laser printing payroIl checks with signature(s), MICR and Arabic numbers. FORMUNIS has received an example of your current payroll check and has reviewed its content. Based on the spool file data from MUNIS, the form field names and form content will match. We require verification of the bank name information and MlCR changes that may be possible. A "tiff" electronic file of your seal or .organizational identity is required if this is going to be added to the design of your payroIl check. Form Output Description Application Part(s) Printer Input tray(s) Output tray(s) Signatures Stock PayroIl Check 1 HP 4050TN 2 1 2 Red Laser Cut Sheet Check Stock When numbering your checks, how many digits will be used for the check number? _ Please note: Financial Institutions requirl~ a minimum of6 digits. (Number beginning 100,001 or more) FORMUNIS requires that each of the form instaIlations outlined within the site plan be reviewed for their accuracy based on the information outlined. A signature indicates the acceptance of and agreement to the information defined within the form application. Modifications from the original specifications will be documented and are a chargeable service that will be billed at $90.00 per change/modification. Signature Date This sheet must be signed and received (prior to the installation). Please return via fax transmission to Joanne Lord at 207 -77 4-0607. Thank you. ~[8J B,~ ,."..omt MUNlS ,--.--- ~ FORMUNIS- CITY OF WINTER SPRINGS, FL Site Plan for Installation November 17, 2000 Form User Application: Contact Person: Live Date: Direct Deposit Notification Rita Hartman April I, 2001 Project Scope · Application Description FORMUNIS will proceed by designing the direct deposit notification (a mirror of the payroll check). The words "non-negotiable" will be printed in the signature area. A "tiff' electronic file of your seal or organizational identity is required if this is going to be added to the design of your direct deposit notification. Form Output Description Application Part(s) Printer Input tray(s) Output tray(s) Signatures Stock Direct Deposit Notification 1 HP 4050TN 2 1 None Customer Supplied FORMUNIS requires that each of the form installations outlined within the site plan be reviewed for their accuracy based on the information outlined. A signature indicates the acceptance of and agreement to the information defined within the form application. Modifications from the original specifications will be documented and are a chargeable service that will be billed at $90.00 per change/modificatioD. Signature Date This sheet must be signed and received (prior to the installation). Please return via fax transmission to Joanne Lord at 207 -77 4-0607. Thank you. ~[]!] B~ ~ FORMUNIS- CITY OF WINTER SPRINGS, FL Site Plan for Installation November 11, 2000 Form User Application: Contact Person: Live Date: Purchase Order Rita Hartman March I. 2001 Project Scope · Application Description FORMUNIS has received an example of your current purchase order and has reviewed its content. Based on the spool file data from MUr,,f[S, the fonn field names and fonn content will match. We will require verification of the number of parts, backer information and color sequence of parts printing. A "tiff' electronic file of your seal or organizational identity is required if this is going to be added to the design of your purchase order. Form Output Description Application Part(s) Printer Input tray(s) Output tray(s) Signatures Stock Purchase Order 3 Print I. Print 2 See Below See Below 2 Customer Supplied Part One Marginal Words Vendor Purchasing Department Stock CoDlor White White White Input Tray 2 2 2 Output Tray Printer Two Three HP 4050 TN HP 4050 TN HP 4050 TN FORMUNIS requires that each of the form installations outlined within the site plan be reviewed for their accuracy based on the informat;on outlined. A signature indicates the acceptance of and agreement to the information defin'ed within the form application. Modifications from the original specifications will be documented and are a chargeable service that will be billed at $90.00 per change/modification. Signature Date This sheet must be signed and received (prior to the installation). Please return via fax transmission to Joanne Lord at 207-774-0607. Thank you. ~[ID EJ~ ~ FORMUNIS.. City of Winter Springs, FL Site Plan for Installation November 11, 2000 Form User. Applications: Contact Person: Live Date: Utility Bill Rita Hartman January 1, 2001 Project Scope · Application Description Laser prints Utility Bill. FORMUNIS has received a sample of your Utility Bill. The content of this form has been reviewed based on the spool data from MUNIS. The MUNIS form field names and form content will match. FORMUNIS will make changes to the organizational identity information after reviewing the current utility bill. A "tiff' electronic file of your seal or organizational identity is required if this is going to be added to the design of your utility bill. Form Output Description Application Part(s) Printer Input tray(s) Output tray(s) Signatures UHlity Bill 1 HP 8100 ON 2,3,4 1 None White Laser Cut Sheet Stock with Remittance Perf FORMUNIS requires that each of the form installations outlined within the site plan be reviewed for their accuracy based on the information outlined. A signature indicates the acceptance of and agreement to the information defined within the form application. Modifications from the original specifications will be documented and are a chargeable service that will be billed at $90.00 per change/modification. Signature Date This sheet must be signed and received (prior to the installation). Please return via fax transmission to Joanne Lord at 207-774-0607. Thank ~[j] l~f~1 [Muir. I .--..---... A FORMUNIS~ FORMUNIS Support Plan Page One SUppOI.t, Maintenance and Consuliting The responsibility for the success of your print and output using the JetForm Central Pro software (for the limited license application) has been transferred from JetForm@ Corporation to FORMUNIS. FORMUNIS support is a recommended purchase to support your installation. FORMUNIS will provide technical support for the components of the FORMUNIS software package. (including JetForm Central Pro™ software) the form designs along with providing consulting for future development. JetForm Corporation will not support the components associated with this installation for the limited license application. Requirement for Support Remote access via modem is required for support coverage under any of our support plans. With pcAnywhere™, FORMUNIS supports and troubleshoots technical issues. Remote support is used for modifications and changes to the electronic forms. Custom Support Plan Custom support is intended for MUNIS customers who modify their own forms from the standard forms collection library offering using JetForm Design T!\.1, customers operating on the UNIX platform or customers using Formunis Postal Software. The Custom support plan provides telephone support (800 line) for two designated individuals within each organization from 8:00 AM to 5:00 PM (EST) Monday through Friday. Included in your support are software upgrades to the ]etForm Central Pro and ]etForm Design software programs (version upgrades) (the support plan does not included upgrades to a full license of ]etForm Central Pro). Also included in the support plan are form design upgrades of the standard form package (these upgrades are available at support renewal, once per year) and technical troubleshooting. ~[!] EH~ A FORMUNIS.. City of Winter Springs, FL Site Plan for Installation November 17, 2000 FORMUNIS Support Plan Page Two Included in our support is business analysis. workflow planning and testing of custom form development. Separate fees apply for form design, product integration and training. This support does not include revisions or modifications required by the customer as a result of form design changes that take place in the normal course of business (see event support). Pricing is fixed on an annual basis and the contract is renewable on an annual basis. Design Support FORMUNIS provides design services for modifications to the installed designs. This service is for revisions or modifications required by the customer as a result of form design changes that take place (in the normal course of busines:s) after the installation. Examples are: (but not limited to) modifications to job management, signature changes, bank changes and/or ADA modification, organization identity changes. software modifications by MUNIS (including field placement or size) and any graphic form changes that require a design change. Most of these events would normally render a preprinted form ob:wlete. Our service charge for electronically modifying the designs remotely is $ 90.OO/event. Event Support For customers who do not subscribe to Premium or Custom Support. FORMUNIS offers Event Support. This support is structured on an event/incident basis. This service is billable at the rate of $180.00/per hour with a one-hour minimum charge for each event/incident. This support is intended for customers that require technical troubleshooting and assistance with their application. This support does not include revisions or modifications to any form designs. software upgrades or form design upgrades to any forms. m[8J [~fo<ml [~~ I A FORMUNIS- City of Winter Springs, FL Site Plan for Installation Novembcr- 17. 2000 FORMUNIS Support Plan Page Thrcc Expandcd Support FORMUNIS offers support to their customers from 8:00 AM to 5:00 PM (EST) Monday through Friday. For support requirements beyond these hours, FORMUNIS offers expanded support on the following basis: l. The support is only available through prior arrangement with FORMUNIS staff during the hours of 8:00 AM to 5:00 PM (EST) Monday through Friday. 2. Support is billable at the rate of $180.00/hour with a two-hour minimum charge ($360.00). 3. The service is intended for disaster recovery and emergency situations only and not intended for services that would normally be provided under the FORMUNIS Custom Support program. 4. FORMUNIS does not guarantee that this service is always available. We will do our best to accommodate individual needs are staffing is available. PLEASE NOTE ]etForm Corporation@ requires customers to repurchase their software when the current version is outdated by three versions. In 1999. JetForm Corporation issued four version upgrades to the Central Pro software program. We anticipate that the same will be true in , 2000, The cost to replace the ]etForm Central ProTM software exceeds the annual support renewal cost for the FORMUNIS Premium support plan. Support Exclusion FORMUNIS support programs do not cover the following occurrences: reinstallation of any software associated with the FORMUNIS electronic form application due to a disaster recovery circumstance or a required reinstallation for new equipment. We offer these services via remote access and these services are billable at a rate of $180.00/per hour. m[8] B~ ;,.~ "~ FORMUNIS.. CITY OF WINTER SPRINGS. FL Site Plan for Installation November 17, 2000 Customer Preparation for Installati,on The network system and laser printers that the ]etForm Central@ software will be installed and printing to must be set-up prior to our arrival. The laser printers must be able to print the MUNIS standard laser format forms to the designated network printers. The standard laser forms can be found as a choice in the MUNIS print application screens. FORMUNIS is not responsible for network problems, hardware problems or a customer's unfamiliarity with platforms. We will consult and troubleshoot these problems to the best of our ability but the ownership of the resolution is the responsibility of the customer. Please prepare ten data records of each form application being installed. Live test data must be available, as we require these files for the first day of installation for testing. Log on password(s) and permissions for FORMUNIS's installation and user testing need to be created before our arrival. We will require their use for the first day of the installation. Customer Discipline Preparation for Installation The project manager will be responsible for coordinating the users and the on site installation. The project manager and/or the IS professional who will be responsible for ]etForm Central administration should shadow the FORMUNIS Installer at all times and make themselves available during the application installation period. They should also be present when we meet with each user. FORMUNIS will provide a sign off sheet on each project. FORMUNIS installation personnel have a very limited amount of time to manage the transfer of all the information on how ]etForm Central works. Our responsibility to a successful installation is limited to the installation of ]etForm Central software, printing the forms we've designed and ]etForm Central's administration training. We can' not be and are not responsible for network problems with printers or platforms that result in problems and failure of our system to perform. ~[j[] I~II~~I 'A FORMUNIS.. CITY OF WINTER SPRINGS. FL Site Plan for Installation November 17, 2000 Installation Scope During the installation, FORMUNIS will require access to a member of the IS department that has administrative rights to thc systcm/network. This individual must have a good understanding of the system and must be available to consult with FORMUNIS during installation. The installation period allows for the software installation and the print output management. At installation time a checklist will be provided and signed by the project manager indicating that the installation and related training has been completed. Day two is spent training the users on supporting JetForm Central. After installation, we will make form revisions remotely (using pc ANYWHERE@ software) and provide phone support. Installation Definition Two installation days are equal to a combined total of fifteen (15) or more hours. One day is completed after five hours. A full day is denncd as any time over five hours worked. FORMUNIS is prepared to work extra hours (on items pertaining directly to the installation of the predetermined project scope) at no additional charge during this two-day period. The project manager also needs to be prepared for a late evening or consider assigning a specific person to stay into the evening in the event that unexpected problems occur during the first day causing more time for the install than normally necessary. Installation The first day will be the installation of JetForm Central'fM and the FORMUNIS™ form package. All users, the primary and secondary IS support person must be available on the morning for training. We will review the print buffer and how to handle security paper, clearing the paper and analyze how many surfaces printed Our training will provide support and education and you will be our first line of support before calling FORMUNIS. m[!] I Wfomt I [~~~ I I I I I I I I I I I I I I I I I I I I [ij[j] I~'I A ~,,,rm !!\JLNJ! IN~RODUCTION TO LASER P1UNTING SOLUTIONS FOR .kfUNIS@ SOFTWARE \,\\\1l1710 ~ 4t ",,~ FORMLlIol'S 11".... 1..~% J" QUJR,'A'N'TEE ~ 11"/" \,\, I!FAt\\ Ai, ,- "i'~ ....~iij kdorm8 EFFECTIVE 9-1-00 I I I I I I I I I I I I I 'A FORMUNIS,,: FORMUNIS STEPS TO SUCCESS Success with a new technology doesn't come straight out of the box. Before you introduce technological change into your organization, you need an implementation plan based on an analysis of your existing systems and your current and future needs. At FORMUNISTM, we don't just supply technology, we work with you to apply that technology to solve your paperwork process automation problems. PRIORITY ONE: Understandin'g your needs FORMUNIS Laser to Mail can do much more that just reduce your paper burden. Saving you both time and money, we help you to automate complex work-flow processes and implement paper work changes that will make your organization more productive, Because every organization is unique, our first priority at FORMUNIS is to understand your specific needs. BUILDING BLOCKS FOR BUSINESS SOLUTIONS The solution begins with the decision to streamline your organization's work-flow processes with the FORMUNIS suite of automation products. But that is only the beginning... . FORMUNIS Solution Professionals will help you to plan and implement the integration of new technology with your MUNIS@ system for maximum improvements and minimum disruption. We'll do the base-line studies and provide the in-depth knowledge you need to understand how this technology will help your organization, We will help identify and design the application that will be applied within your organization, . The FORMUNIS Solution delivery team will provide a structured, proven engagement system for successful project delivery. We will do the hands-on development providing detailed form design, project management, development and seamless integration with MUNIS. The FORMUNIS delivery teams have broad experience and are skilled in the issues that arise when integrating Jetform with MUNIS software. FORMUNIS products and services are the building blocks for success! FORMUNIS Solutions: The experience will exceed your expectations Still struggling with old-fashioned, inefficient, paper based processes? FORMUNIS Solution professionals can help you to: . Extend the value of your MUNIS system . Reduce the costly dependence on pre-printed forms . Re-engineer work-flow to increase productivity ~orm~ I I I I I I I I I I I A FORMUNIS", FORMUNIS Engagement Process 1) Introduction. FORMUNIS is happy to provide you with this comprehensive package. It is our hope you will find this package of information helpful. This information is sent to introduce and explain our Financial, Tax and Utility Billing products, Included are examples of the many styles of electronic designs that our clients have chosen. 2) Pricing . FORMUNIS will provide you with general pricing upon request. Our purpose is to provide you with the information needed for your general budget requirements and planning. We realize it is important that you know all the costs associated with our solution components. If you are interested, we will provide you with a Fixed Cost Contract for our services. The fixed cost contract is prepared after a conference call which reveals the project scope for each individual application, 4) Technical Requirements Call. Once you indicate continued interest in our products and services, a short technical phone call should be conducted with a member of the FORMUNIS support group. This call will determine if your site meets the technical requirements needed to use our products and services, We wish to be certain the work station, network and printers you have can be utilized. If you wish to do so, at this time we can complete the testing and preparation for a dial-in demonstration of our services. 5) Conference Call. FORMUNIS highly recommends a dial-in conference call. The call allows us to demon- strate our products and educate the decision makers in your organization, This will allow your team to evaluate our products first hand and demonstrate how easily we can support them remotely as well. After the dial-in conference call, we would generally recommend a site plan interview. . . 6) Site Plan Interview. This interview takes place via telephone with your project manager and end users to outline the requirements as they relate to your installation, The information gathered during this call allows FORMUNIS to prepare a written project scope, fixed cost pricing and the project plan known as the FORMUNIS Site Plan, Along with the Site Plan, FORMUNIS will provide you with the licensing agreement, written techni- cal requirements and the design requirements necessary to prepare and execute a successful installation, 7) Site Plan Follow-up. A FORMUNIS representative will telephone you to follow up on the materials sent. We will review the information for ,my questions that you may have and discuss any changes to the site plan that you may require, Revisions to the site plan are made (if applicable), and submitted for your approval. Additionally, an installation date is established. There is generally a two week period needed for pre-install work which begins after the install date is established and the appropriate materials have been signed and returned to FORMUNIS, 8) Pre-Install Process. In our Bench Testing Data Center we have the MUNIS application, the equipment, software, designs and supplies that are the components for your install. All of the components for your installation are thoroughly tested before we ship them and install at your site. teJform$ I I I I I I I I I I I FORMUNIS Engagement Process 9) Installation. On the agreed upon installation date, the FORMUNIS software, form designs, job manage- ment, equipment and any additional software are installed, Because our solution is seamless to the users, most of our training is conducted with the IS professionals or administrative personnel. Additionally, we review operational and security issul:s with the users involved with processing the forms, FORMUNIS provides a client review and exit documentation package, including everything necessary for the bank testing of checks, 10) Installation Follow-Up. A FORMUNIS representative will contact you to ensure that the installation has gone well and that you are satisfied with the end result. 11) Annual Renewal. Ten months after the installation your files will be reviewed for upgrades and reor- ders. You are reminded of the need to renew your support contract in order to ensure uninterrupted support, At that time, you are also advised of all the new products and enhancements available. . - - tetform8 I I I I I I I I I FORMUNIS The company we keep... In the last year many FORMUNIS customers have succeeded in reducing their costs and improving their paperwork processes with our LAS E R TO MAl L ™ products and services, FORMUNIS will leverage our experience with your installation to assure your success with improving your paperwork processes! City of Auburn Hills, NY City of Beverly, MA City of Brockton, MA Broward County Sheriff's Office, FL Buffalo Board of Education, NY City of Buffalo, NY Cabarrus County, NC Town of Canton, MA Capital District Transit Authority, NY City of Council Bluffs, IA Carrol/ton Board of Education, GA Clinton County, NY Colquitt County Board of Education, GA Cortland County, NY Dare County, NC City of Darien, CT Delaware River & Bay Authority, DE East Orange Water Commission, NJ City of Fitchburg, MA Town of Framingham, MA . . . City of Glen Falls, NY City of Gulfport, MS Village of Hempstead, NY Henry County, VA Town of Huntington, NY City of Johnson City, TN KenmorejTownawanda Schools, NY City of Lauderdale Lakes, FL Liverpool Central School District, NY City of Long Beach, MS City of Lowell, MA Lowndes County, GA Lowndes County Schools, GA City of Lynn, MA Macon County, NC City of Martinsville, VA Mohave County, AZ Montgomery County, MD Town of Nantucket, MA OCM Boces, NY Oldham County BOE, KY City of Oswego, NY Piedmont Behavioral Healthcare, NC Pitt County, NC City of Plattsburg, NY City of Port St. Lucie, FL Town of Ridgefield, CT City of Salem, MA City of Saratoga Springs, NY City of Schenectady, NY Scott County Board of Education, KY Town of Shrewsbury, MA City of South Portland, ME Town of Tewksbury, MA Walton County Schools, GA Westchester BOCES, NY Town of Weymouth, MA Windsor Public Schools, CT City of Woburn, MA ...and what they have to say about us! We use forms created by FORMUNIS to print our AlP checks, our payroll checks and our direct deposits. They are printed on laser printers, are very professional looking and easy to produce out of MUNIS. Additionally, the folks at GBF are very responsive and pleasant to deal with. - Suzanne Loli, Broward County Sheriff's Office Growing School Districts are looking for new ways to be efficient in operations. FORMUNIS is a significant time saver for our accounting staff, I am excited about the simplicity and multi-tasking ability of the software, particularly for Purchase Orders. - Chuck Littrel, Oldham County Board of Education The City of South Portland, in partnership with MUNIS and GBFIFORMUNIS, has successfully implemented FORMUNIS for payroll and accounts payable checks, direct deposit advices, purchase orders and accounts receivable invoices. The city has been very pleased with the efficiency, security, flexibility and quality of output. We like the self-mailer style, this helps to keep our employee deductions confidential, and the signature card added another measure of security. - Raphael St. Pierre, City of South Portland tePorm~ I I I IIII A FORMUNIS~ FORMUNIS JOB MANAGEMENT FEATURES - - - Output Management A FORMUNIS~ LASER TO MAIL Electronic Forms Printing, Signatures, Fonts and Fonn Desig ns. JOB MANAGEMENT DATABASE OUTPUT MANAGEMENT Job Management, Select printer, paper tray, stod:. output or mail bin options. . t Q~!Step Laser to Mail includes HP 4050 (1000/Hour) NT Workstation or Server FORMUNIS Applications GUI Forms Control JETFORM OUTPUT FILE .. OUTPUT FILE f!\~ ~ ~Postal Sorting 1"1.1.1.1.1,,,11 E-mail (Future) UNIX MUNIS Applications A MUNIS ~-;.~-~'~- - .",0.;:';, -" _:.-0: ..1...,...'....... ._- F . ~.~.~...,. ~j lmage/V'_ Form with Adobe Acrobat Reader Lexmarl< Printer " mn lI:OfoIOU)QD. ((MWoft' ASP Bill Processing HP 2100 (1Ooo/Hour) Documenl Management Q~,~Step Seam! Chedc ''9,,;ng with Signature Card Fax Madline (Future) m HP 8100 (2000/Hour) Mail Bins 3000 Sheet Capacity - - - - - Control how and where a form is printed. Extend MUNIS print applications to every department: local. wide area network or Internet all users have output control. The Jetform printing solution allows you to print specific forms to specific printers unattended. Jetform Central Pro provides printer control of the input tray and paper selection, intelligent duplexing (prints both sides), mail bin selection for up to eight exit trays, and signature requirements for all forms. Distribution of printing to multiple printers, multiple locations and printing different forms at different locations. Secure control of signatures. Forms Output the Way You Want It jePorm9 I I I I I I I I I I I I I I I I FORMUNIS Laser to Mail FORMUNIS provides processing equipment for self-mailers or laser cut sheet applications. These products provide a seamless integration for the mail-processing portion of this solution. In addi- tion to integrated leading edge technology, LAS E R TO MAl L products are designed for efficiency and ease of operation, The folder/sealer enables you to save processing and handling time by finishing your pressure seal documents in one step, If you prefer a traditional form and envelope product, then the folder/ inserter product is for you. This equipment allows you to insert multiple documents into one envelope, Some customers choose to use a folder/sealer for one form application and a folder/inserter for another form application, Both processes are guaranteed to work as part of the JetForm Central! FORMUNIS solution. The FORMUNIS OneStep system creates popular self-mailer styles directly from the HP 4050 laser printer, Checks and federal tax forms are ready to mail at 1000 forms per hour. All components are supported by FORMUNIS. Questions you may have for FORMUNIS regarding LASER TO MAIL processing equipment 1, What are the advantages to the folder/sealer versus the folder/inserter? 2. How can a form application be designed to work with either process? 3. Which process is best for my application? 4. How fast will this equipment finish my document? 5. Will the equipment run unattended? 6, Will my users require special training for this equipment? 7. What type of maintenance is required on this equipment? . . jeJ:form@ I I . I I A FORMUNIS,. FORMUNIS I I Forms Processing Equipmen I Laser to Mail FS 130 Folder/Sealer I >~'j';iTi. ~!_t~ ~:.~--~ ';.'lj .'" ,L 1\ .. . "- c "'"' , ,'.'.-.>' I I I LASER TO MAIL is pleased to introduce a new generation of self-mailing equipment with the FS 130 model. Standard features include a six-digit counter, jog control, fault detection, LED indicators and an operator friendly touch-pad. Up to 200 forms can be loaded in the hopper and processed at speeds up to 9,000 sheets per hour, 14" form length capacity, paper jog control allows operators to jog forms through before operation. Noise reduction: top and side covers are insulated to reduce operating nois . All of these features make the FS 130 the perfect solu on for streamlining your LASER TO MAILproc sing, Tray Capacity 200 sheets (24 paper) Fixed Speed Up to 9,000 sheets our Duty Cycle 75,000 M thly Machine Weight 90 Ibs. Price $ 796 Two way mailers 14" form length, Tray Capacity - Sheet Thin paper tolerant down to Tray Capacity - Envelopes Fixed Speed Up to Duty Cycle Machine Weight Price I FI 115 processes 1,600 sheets per hour, compared to 160 sheets per hour by hand The FI 115 is a fully automatic two station desktop fold/insert! sealer. The machine is fully equipped with automatic settings making it easy to use allowing the operator to load up to 100 pieces in each station, Unique sensing devices signal the operator if the machine runs out of materials, preventing improper inserting, Machine offers nine pre-set fold applications, single and double fold options and a fold only option (seal and non-seal capabilities), Insert up to five sheets, reply cards, plain or window envelopes (in various sizes). No formal operator training is required. I I I I - I ~ '-L::::J E~ * *Please call us for information on the many models that we have available. Whet er you are lo,oking for pressure seal or traditional lase cut sheet solutions, FORMUNIS has the right equiqment to fit all of your forms processing needs. . - . - - 100 13.75Ibs, 100 1,600 letters per hour 10,000 Monthly 661bs, $ 7,695,00 jeJ:form 0 I I I I I I I I I I I I I I I . . I I I A FORMUNIS~ Qne Step TIi'e most affordable . CH E CK S and effident . PURCHASE ORDERS Print Ma'nagement System . FEDERAL TAX FORMS foralltypllSofMUNISforms . BilLING FORMS m[j] A. t!\~J! Eliminate laborious folding, stuffing an sealing tasks. Forms are printed. folded and sealed - /I in one easy step! Ready to use MUNIS form templates are easily installed. Print 1000 checks per hour. Unattended high quality printing, Complete [~- :.-"'1 I , : I Proofing/Sealing is confidential. Social security numbers and deductions are printed and prepared out view of everyone, Checks and forms are ready to mail. esktop Mailing System FORMUNIS has responded again to the growing needs for laser processing for MUNIS customers. The new laser to mail system streamlines all of your mailings such as payroll and accounts payable checks, federal tax forms and utility bills. Laser print, fold and seal - all in one easy step. Create your own secure checks from controlled stock, digitized signatures and protected bank information. FORMUNIS provides seamless integration with existing MUNIS software. You ~Iet professional, high quality, secure, laser printed documents from your MUNIS data. We have pricing and product features to fit all the needs of our FORMUNIS customers, and a professional support staff to serve you, For~7Js Output the Way You Want It r.rJa I I C~" ~., . fJ~~ SIgnIng I ~[j] B ..A. ~J! I I I I MUNIS Software Application Signature Card Laser Printer I I Secu rity the Way You Want It Electronically Signed Form I I . - - A print card facilitates the storage of printer resources such as signatures. The signatures are stored on a PCMClA card and downloaded to the printer's RAM when the card is inserted into the mJdule.The signatures are deleted from printer memory when the card is removed or the printer is reset. Your printer resources for check printing clnd other secure applications can be locked away for security reasons, with no long term storage in the printer memory. The module is parallel connected to any laser printer allowing data to pass through the module. It can be physically attached to the printer to save space and can even draw power from some printers, eliminating thE! need for a separate power supply. Red LED indicator lights for system power and when resources are downloaded. The cost of $1500 includes cables, a PCMOA card (with up to two signatures), E13B MICR font and numeric font. Additional cards can be purchased and new signatures can be added at a cost ofS 150 per signature. Maintenance and support are available on an event basis for $100 per event (after the expiration of the 90 day warranty period). Contact FORMUNIS at 800-451-1709 for more information. Forms Output the !May You Want It ~orm0 I I I I I I I I I I I I I A FORMUNIS~ ~[!] B A ~~J! For those who thi out k of the box. Complete Hardware and S ftware Package Now Available . FORMUNIS workstation pre-loaded wi everything you need. . Save money on acquisition costs an set-up of equipment. . Reduce standard installation fees ith our value added package. . Get HP's Vectra VL400 Series PC orkstation known for its stability, manageability, and securit features. . Easy integration with HP an other printers. . Preloaded with Jetform Ce tral Pro., your form designs, related Job Management Database (JMD), Graphic User Interfac (GUI) for your administration and control of printers, and all service software required f FORMUNIS remote support and MUNIS integration for seamless user processing. . . Workstation . Stable Windows TiIll operating system (Windows 2000 ready) included. . Fast Intelilll pro ssor, 128 MB RAM, 10GB HD . Reliable 3Co network interface card. . 56K internal odem. Forms Output the Way You Want It Monitor not included. I I I I I I I I I I I I I - A FORMUNIS~ Optimize m ~ c) ~~~~al Savings I~'I _.~ _.___-d.< \ ~~ddress Correction and Sorting Module----- / Our easy to use module meets all U.S. postal service mailing I regulations to give you maximum postage discounts /l and fast delivery of your mail. L L C__~ 1-. CASS CERTIFYING PAVE PRESORTING 'f7~' ...1..111' .',.. ,.,.,. A t!\JI!IJ! · Save time on mail preparation and increase your response rates. . Complete Database Management · Merge/Purge Tools · Easy to use with Windows Design and "wizards" /l Increase address accuracy and speed delivery of your mailings with CASS-certified (Coding Accuracy Support System) address-assignment that lets you: . Add Zip+4 Codes, carrier route codes, and POSTNET delivery-point barcodes on mail pieces. . Prepare your files for NCOA (National Change of Address) processing. . Create and print an ACS (Address Change Service) keyline. . Find duplicates to eliminate unnecessary postage and printing costs. Save preparation time and money on postage with PAVE-certified (Presort Accuracy, Validation, and Evaluation) presorting capabilities that: . Presorts mail to meet USPS regulations. . Perform up to four presort schemes in one pass. . Support walk-sequence file information. . Merge multiple mailings for even greater savings. . Print complete, ready to sign USPS mailing statements. Forms Output the Way You Want It r.r.ra I I I I I I I I I I I I (fj I 0 0 0 0 . 0 . 0 0 FORMUNIS INTEGRATED [j] A M'l~J! EL TRONIC DOCUMENT AGEMENT SYSTEM o o 0 000 0 0 0 0 0 000 000 0 0 o o o o o o o o o Archive docum)ents for easy retrieval 0 0 0 0 0 for on screen viewing or re-printin / o o o o o o o o o o o Works with JetFor I Central : to electronically archIve a r 0 of your printed doc~me ts. 0 0 0 0 0 / 0 Archives any_Jet Form entral c;locumenfincludin hecks, purchase orders, a \:l invoices. o o 0 0 0 0 0 0 0 0 0 0 0 0 The e o~hiVing proce creates ) 0 0 0 0 0 0 0 0 Ado Acrobat (PDF) files of ur outPlitln the b ckgrm;nd. o o o o o o o o You choo~e tojarchive as you print J or even archivej9stead of printing. Automatically'generates one output .-;' fileJor'each document for quicksearching and retrieval. o o o o o Works with your existing Electronic D6cument / - - Management System (EDMS). The ArchiveModule outputs to-anyEDMS that can import an ASCII index file. o o o o o o Or create your own indexes with eDocs' Autoratic Indexing feature. As it Y1lS, eDocs automatically indexes y'our archives (evenW'ith indexed file names) for fast and easy retrieval. Up to 30 indexes are supported. o 0 0 0 0 0 0 0 0 0 0 Forms Output the Way You Want It ~orme I I I I I I I I I I I I A FORMUNIS", FORMUNIS Laser Printers Laser Printers FORMUNISTM is a Hewlett Packard@ Solution Provider. As a Hewlett Packard Solution Provider, FORMUNIS is the first to learn about additional enhancements, options and features for the HP line of laser printers. We also exchange information about our current JetForm CentraljFORMUNIS applications so we can guarantee that Hewlett Packard printers support our laser output solutions, We feel it is important to make recommendations and provide information to our customers on the laser printers available for this application. FORMUNIS is trained in the area of laser printers. We encourage you to leverage our knowledge to provide you with technical information when considering laser printer purchases. A few questions you may have: 1. What ;s the output speed of the printer we are considering? Will that speed meet our needs? Does the printer print both sides? 2. Does the printer have adequate paper trays for the printing output and work-flow we want to accomplish? 3. Where do I purchase magnetic toner for my check printing applications? 4. Can I print to other department printers? . Most MUNIS@ customers can purchase their laser printers from the retail outlets or through state and local government contracts. The JetForm CentraljFORMUNIS application can work in conjunction with other laser printers that already exist within your organization. Enclosed are technical data sheets for the Hewlett Packard 21 DO, 4050 and 8100 laser printers. We would be happy to share our knowledge and experience with you when considering a laser printer purchase. Toner FORMUNIS supplies a full line of laser printer toner including OEM (original equipm~nt manufac- tured), recycled and MICR (used for laser check printing). Our toner products have been carefully selected to provide you with a wide range of quality choices. Contact us for information and pricing! jeJ:form0 I I (01 b Q I I I 0' I ~ rg U o ' I ~ I I o I u w n, (01 I I I I I I I . - -- - - . - LaserJet 2100/2100M/2100TN I I - - . - . - - - - ~ . .. . __I HP LaserJet 2100, 2100fN, 2100M Ultra-sharp print quality and much mo now more affordable than ever The HP LaserJet 2100 series printers are designe for people who demand uncompromising quality in everything ey do and have a sharp eye for value, Most impressive is the t 1200 x 1200 dpi laser output, the highest in their class, whic creates documents that demand attention with crisp, razor-sh text and stunning graphics, There's also the HP UltraPrecis Toner Cartridge for sharper text and graphics plus exceptio al grayscale for compelling graphic images, Each pag ou print will impress you and your audience! Sharper, faster and mor expandable HP LaserJet 2100 series printe deliver 10 pages per minute with no compromise in qualit~ Two paper trays boost productivity, A 66 MHz processor and 4 M of memory are standard for fast printing of complex pages. ast Infrared and HP JetSend deliver quick and easy walk up p . ting from a variety of pes, palmtops and other digital devices Ideal for individ als and small workgroups - 2100M and 21 OTN- The HP LaserJet 2 00 series printers pack all of these advanced features into a so tion that is affordable and compact enough for virtually any w king environment. The HP LaserJet 2100 is easily upgradeable t all the features your growing business will need, The HP Las Jet 2100M comes complete with HP PostScript Level II e ation and 8 MB of memory, It is designed to excel in mixed I uage environments. The HB erJet 2100TN is network-ready, right out of the box, .th a pre-installed HP JetDirect 600N (EIO) Internal Print Se er. Small workgroups will benefit from the flexible media, ze capabilities and increased paper capacity, Set-up and maintenance are simple, with HP JetAdmin software integrated into the installer. Choose the HP LaserJet 2100 Series printer that is right for your business today! Flin- HEWLETT~ ~a PACKARD I Expanding Possibilities I Printers HP LasEJ:fet 2100 series - the soluti n that puts "quality", "per ormance" and "value" o he same page uality · True 1200 x 1200 dpi resolution · No speed compromises at highest print quality · Excellent grayscale and detail for compelling graphics · HP UltraPrecise Toner Cartridge Performance · Fast 10 ppm output · Prints on a wide variety of media and sizes · 4 MB of memory standard · Fast Infrared and HP JetSend for walk-up printing from a variety of PC's, palmtops and other digital devices Expandability · One EIO slot for optional HP JetDirect 600N IEIO) Internal Print Server · Optional 25o-sheet additional paper tray for total 6oo-sheet capacity and mixed-media use · DIMM slots for up to 52 MB of memory · Optional HP PostScript level II emulation for mixed language environments Economy and VaLue · 5,000.page toner cartridge capacity (with 5% coverage) improves cost-per-page . Network-expandable . Accessories priced for economical upgrades · HP quality for dependable performance · 1 Year Express Exchange Warranty HP LaserJet 2100M Adds All of the above, plus... · HP PostScript level II emulation for mixed language environments · 8 MB of memory standard HP LaserJet 2100TN Adds All of the above, plus... · Installed HP JetDirect 600N IEIOllnternal Print Server · HP JetAdmin software integrated into installer for easy set-up and maintenance · 25o-sheet additional paper tray for 6oo-sheet total capacity I I m ~ 3 I I I LaserJet 4050 Series Printers r; HP \j 17l~g~~r-minute black-and-white network printers. '-. ../ I I I I I .'.;"5" "+.'. ~.J ~~ "," "'~', t ,~\",.." I Redefining workgroup printing with innovative soLutions. I The world's best-selling laser printer just got better, Introducing HP LaserJet 4050 Series printers- the new replacements for HP LaserJet 4000 Series printers. The 4000 Series earned their status as the industry standard for black- and-white workgroup printing by offering the most performance for the money-right out of the box. Now we've added a number of powerful features to the next generation 4050 Series, creating an altogether new and improved benchmark against which all others will be judged. HP LaserJet 4050 Series printers improve upon the traditional workgroup laser printer in three key areas: overall performance, versatility and total cost of ownership, Performance is boosted by the new 133-MHz microprocessor that comes standard in all models. And HP LaserJet 4050 Series printers feature twice the amount of I I memory that was included in their predecessors. What's more, they offer a versatile, expandable design to accommodate general office or specialized printing needs-both today and in the future. The upgraded security, management and convenience features of HP LaserJet 4050 Series printers deliver a new level of usability and manageability that was once available only with more expensive department printers. Designed as part of a complete network printing solution, HP LaserJet 4050 Series printers make it easier and more affordable than ever to print what you want, how you want it, when you want it. HP LaserJet 4050 Series printers also include award-winning service and support through HP Customer Care, and one feature you can't get anywhere else-legendary HP reliability, F/idl HEWLETT- ~~ PACKARD I Expanding Possibilities] CrnA-Ll ?rt n ~(L,- Great-looking output, even faster. . HP Pro Res 1200 gives you true l200-dpi quality at full engine speed . New I33-MHz RISC microprocessor for up to 40% faster processing Twice the amount of standard memory at no additional cost . With 10 million JetDirect solutions installed around the world, the IO/IOOBase-TX JetDirect card (with N and TN) delivers the reliability you expect from HP, along with increased network throughput . HP Transmit Once minimizes network traffic . Dynanlic RIP-once for faster processing of multiple original prints (mopies) · Designed to print up to 65,000 pages per month Versatile design to meet today's business printing needs. · Fast IR receiver allows for wireless walk-up printing to accommodate the needs of mobile professionals . New convenience features, such as Private Printing, offer more control over how and when confidential jobs are printed . Create additional copies of a print job directly from the control panel using Quick Copy . Frequently printed jobs, such as fax cover sheets, can be stored on the optional disk drive and printed via the control panel . Expandable design offers the perfect printer platfoml for both general office and specialized printing needs, providing seamless integration of paper handling accessories and Oexible connectivity in virtually all network environnlents Lower total cost of ownership. . TonerGauge teclmology monitors toner usage to help you minimize printer downtime and take the guesswork out of ordering printing supplies . HP Web JetAdmin network peripheral management software makes it easy to install, configure and manage right from your desktop, saving time and IS dollars . Expanded Control Panel Help assists with troubleshooting at the printer, reducing help desk calls . A range of Oexible service options and warranty packages is available to meet the needs of any business I I ~lO< ~~' I I I ( HP Printers (' I' \ 32-'pagJper-minute, high-volume black and white \ rk I . netwo. 'pnnters. I I I I I I Buy an HP LaserJet 8100 Series printer For its performance. Love it For its versatility. I If you've been looking for a 32- page-per-minute (ppm) printer with HP quality, innovation and reliability, your search is over, Because HP LaserJet 8100 Series printers offer high-volume users unrivalled performance, versatility and manageability, I I I As the performance leaders in the HP LaserJet printer family, HP LaserJet 8100 Series printers incorporate the sophisticated technologies of HP LaserJet 4000,5000 and 8000 Series printers, HP LaserJet 8100 Series - - - printers also include a host of new security, management and convenience features that ensure fast, great-looking output with an overall low total cost of ownership, Designed as part of a complete network printing solution, HP LaserJet 8100 Series printers include HP Web JetAdmin peripheral management software, HP JetDirect 600N (ErO) Internal Print Servers and award-winning service and support with HP Customer Care, Fli;' HEWLETT' ~I:. PACKARD [ Expanding Possibilities I B\5 ~\\n~(U High-performance, high-voLume printers. . New 32-ppm engine with 166-MHz RISC processor reduces waiting time for output . HP Transmit Once minimizes network traffic . Dynamic RIP-once for faster processing of multiple original prints (mopies) . 16 MB of standard memory (24 MB on HP LaserJet 8100 ON model) makes it easy to print even large, complex documents . HP FastRes 1200 for 1200-dpi quality without the usual network congestion and speed penalties . Designed to print up to 150,000 pages a month VersatiLe, hassLe-free network printing for any business. . New Job Retention features, such as Private Printing, offer more control over how and when confidential jobs are printed . Create additional copies of a print job directly from your printer's control panel . Frequently printed jobs, such as fax cover sheets, can be stored on the optional disk drive and printed via the control panel · HP Web PrintSmart provides improved Internet printing and management . HP Internet Installer and Oil Change for HP Customers give you automatic access to the latest printer drivers . Flexible, customizable paper handling increases productivity while reducing trips to the printer . Technologies, software and operations com- mon to HP LaserJet 4000, 5000 and 8000 Series printers Low totaL cost of ownership. . HP LaserJet C4182X Ultra Precise maximum- capacity toner cartridge produces 20,000 pages (based on 5% average coveragel . Cost-per-page of less than one cent · HP TonerGauge monitors toner usage to take the guesswork out of ordering printing supplies . HP Web JetAdmin peripheral management software makes it easy for network adminis- trators to install, configure and manage net- work printers right from their desktops · Backed by HP Customer Care for full-service support, including troubleshooting tools and phone support I I I I I I I I I I I I I I I A FORMUNIS", FORMUNIS Contact Information EXPERIENCE VS. EXPERIMENTATION You can't afford to experiment when you're implementing a key new technology in your organi- zation. To maximize your return on investment in FORMUNIS you'll want to implement as many of our components as possible at installation. FORMUNIS will provide a core technology to your organization, improving productivity and work-flow processes. To achieve that goal with a mini- mum of disruption to your operations requires experience, At FORMUNIS, we have that experi- ence. We take pride in the knowledge and abilities of our solution professionals and delivery teams, We understand that every organization is different with different goals, different requirements, different systems and different people. Working with large and small organizations all over the country, we have developed both the methodology and the management skills to successfully integrate JetForm technology with your existing MUNIS system. If you require additional information or pricing for this solution, please contact: - I Cliff George President FORMUNIS 501 Forest Avenue Portland, Maine 04101 207-774-1482 800-451-1709 email: cgeorge@gbfinfo.com . I I pporme . . THIS DOCUMENT CONTAINS ULTRAVIOLET FIBERS,'A COPY VOID PANTOGRAPH, CHEMICAL ALTERATION STAIN FEATURE AND AN ARTIFICIAL WAT,ERMARK ON THE BACt( I ' ,':\.<.\..:,,VdU r.;:O rg~ r1t~at~~~~,tii' .' ":':~':",:',.', ::',:::."':';:',t. ':AAn' 'yi~C".B!"ty.,...a,;.::;:',~.;:S,.,~,.',.,T..',:;.,..;,','..:,.,;,',',:,:.,.,.:,:.~,',',.,/.:,:1..:,...,;,2,O..~O:,~.:,..'O~.. 5,', .::':;~N:":":'::"':::;':-" .. . ':::,;<' .~' . ., . ,)':::,,/';:":~CH~gk' OO<DQ@1 ,.. ':':;~~;~'~i~~,i~;~e~~~~~.":';::?~m:';:'. :;"",:,;:;,.); "c"',;:,.. .. '.';::;;,:..:'.;,:,,',:..>.::,.:. ",;,::>,..,., .UrTl er.,' ' . t ,'. ),.j,.,.,..,,',',.a;r..y.~...T:,:..*,:O...;T...,.,I,'h:N.,~io,.urHd~:.e~Nr.,ro..s,,;,D,lt.~..,..,:s.:,:,";~,::i~~~~If~~~;,~b~I~~~~iift;~~. .:jj~l,~; >~~;2~~:~,:::::r;::f:;~~1j . r-:. . . ._~.:.\::<~;: ;::f:;.....\~...~~. , ~.'~'... ' ~ ;:'''''''''';' 0.:1::35.,. 0..13. 5~~;47 ' ." <:ir""'i:^i:"'i;;:::'f;~~; "^Q~~' ,<', .,<, .. .. .. :~. ',....~.',.'".,.,' ..1 . .. .... - ~ ;>" . JOHN",POE:",.\ , ,....8:,':. 'w..,"..,.,;...." " ":,:,:.::";".~,:,;,, " ^, ",:} : .:;,.: ..' '.' ',^ , .,:..,'. "" 123'AUBVRNSTREET ,y'"::'':',,::,''' ,.. .: ,',. "', <" ;" i; ".,. :.~~~~,;,",?~~-., .~'~, .--q:,;:~~~zn.Ho7i;ZEDsiGNA'TyRE~P '.' PE~~1.S;~~W;MArNE~~:~R,1,:: ,,' .,'H' :: .:,::,~:'::",:"<~: ':,,; ,'.'<"'::' :~' .::i' . '~. '~,e;, ":-:,' '. .:,~::~'c ,> ::; ':'.".': 1.l1;,;II",II",II",II",II";il~~,n,,,II;:~IJ,,;I, ',' ',__,.,_,_"___ _._,__.____._,~___. . .... ,,,.... " .,' " . ""';";:,:' ".~~' .'..' , . AUTHo.RIZED SIGNAWf.lEI\IIR",,:,,'A ":,, ',,::i::>"::':':::':"'::'?'::~:::',':,": '::\t;b iD:~,t::~, ", ',>;.,., , .., : .. .. " '" .', " .,'.',. "-!:?"" 'F. 01'1\5- 11100000 Jptl!- 9~}-3"" ~ 5 ~81: ~.... 5"' ~o 2111 :"1 Your Organization, Any City, ST 00000 .. :> V> u -' o a: >- <( "- on 'c ::> E (; u.. Emp No,. .., Employee Na,me Sac See No. . "p'e,[iod ,Endin{l .. Check Date Typ~^ ^ Check Number . .,'" - ~ .. ~ .~ .." -., ._. .' .-... - .. ' . . - ,..-.., .... 11755 JOHN DOE 000-00-0000 01/31/00 02/02/00 WEEKLY 000001 Type/Ho~rs Ei:lrninQs . Deductions Year- To-Date .,.. .. . -'. .. , ..' -.. REGULAR 25.1703 1,761.92 USCM PEBSCO 70.00 EARNINGS 1,814.78 EDINC 52.86 FIT 196,94 FIT GROSS 1,562.80 SIT 96.48 FIT 196.94 CBRET 2% 13,22 SIT 96.48 CBRET 7% 127,03 CBRET 2% 13,22 ADD WAGE ADJ 4,20 CBRET 7% 127,03 BC/BS B I C 32,31 DNPPO BI.5CF 5,22 ESO LIFE 24,70 BASIC LIFE 1.40 GBF CREDIT 311.00 Totals Accrual Usage , Remaining Balance . .. , . TOTAL PAY 1,814,78 SICK(H) 0.00 12.31 DEDUCTIONS 882.50 V ACA(H) 0.00 7.38 NET PAY 932,28 PERS 0.00 0.00 TAXABLE GROSS 1562,80 C;; '0 15 e B en o ... '" .. g ex:> ro u HAVE A WONDERFUL WEEKEND NEW INSURANCE FORMS ARE NOW AVAILABLE IN THE ADMINISTRATORS OFFICE 'IOl:P. P,IDO;:JSE,:,E~T iN Y;';E ~ZOVE t:REA Oil!l '! DO ,')0 r SIG"'!, Vo!~IT~ OR STA,V;P BE~O\.'V THiS UII'~ FOR ~EPOSnO;w BAiW USE ONl.Y ~.~_._._...~~~----- ._.~ -----..---=-=----:;--,-= SUeSEQUENT COl.lECTING BAII'K USE ONL Y Your Organization P.O. Box 000 Any City, ST 00000 Payroll Account FORMUNIS,. .... , ID ~:.~,.. ***NINE HU~~~~~A~~~~dl't?ARS AND 28 CENTS Advice Number 000001. , A.dy~e Q<3!.L ~_ 02/02/00 _ ..t>.clyice,. ~,rnqgl1t...... ____,. $932.28 Deposit To The Account Of '0135 01350074 7 JOHN DOE 123 AUBURN STREET PORTLAND, MAINE 04101 11111111...1111.1111I11...1111.11...11...1111.11'111 NON-NEGOTIABLE DIRECT DEPOSIT Your Organization. Any City.ST 00.0.0.0. Emp l'J(}',. 11755 l:Vp~[Ho.':lr~_____ EmploYil~ N.'I'!le. ___m.. JOHN DOE Soc Sec NO'.I"i:l.!iog .~rldJ!!g.,_... Advice Date 000-00-0000 01/31/00 02/02/00 _._ ::ryp,~_:,,_._, Advice Number WEEKLY 000001 _Y~.a!~::ro:Q?!e,__.. ,'.__ ..", _~a!rlings ____._._2., _ ..,().eductions REGULAR .25,1703 EDINC 1,761.92 52,86 USCM PEBSCO FIT SIT CBRET 2% CBRET 7% ADD WAGE ADJ BClBS B I C DNPPO BI.5CF ESO LIFE BASIC LIFE GBF CREDIT 70,00 196,94 96.48 13.22 127,03 4,20 32,31 5,22 24.70 lAO 311,00 EARNINGS FIT GROSS FIT SIT CBRET 2% CBRET 7% 1,814.78 1,562.80 196.94 96.48 13.22 127,03 oi :> lfJ u o o >- <l: a. '" '2 ::> E o u. ~ '0 o ~ 8 en o .... _. "' .. o o 00 '" u TOTAL PAY DEDUCTIONS NET PAY .J'o,l<3!L _ _____ 1,814.78 882.50 932.28 AccruaL\,JsClge,. . SICK(H) 0.00 VACAIH) 0.00 PERS 0,00 ~ema,ining Balance, 12.31 7.38 0.00 TAXABLE GROSS 1562.80 HAVE A WONDERFUL WEEKEND NEW INSURANCE FORMS ARE NOW AYAILABLE IN THE ADMINISTRATORS OFFICE , ' : : :..::::JI -j :-"""1 : : , ' :;cl (1) o .., Cl. ~ .. j o > I ~ ~i \(!'lndor r-Jo~. 0000100024 _ flllt~~.p^a!.EL" 04/04/00 Cfl , q i m I I S;l I ::: I C) , ______I___~, t - -. I Call BOO 451,1709 to reorder. Formu",s APPS V 4 1 I 1"- ~~~'-z;- ~:? ~ ,,=5:r~ :;~r--~~ ~ r";~-~~ ;~~:~'~~,~:~ ~~:~-~, }~- '~~ ~'~!:-i - x'~-:~ ~~- ~~~~i- -~ '~"~~r-~'~t:~~;(~~J{:,~r c _~,-- :Your/0rganizatio'n 'i,l, ,\' ;,.1,,- , ~Any ~ank ~.~-_ / !.-. 12-3!1.5 ~ 17. -,..:Checl('. ,,:, 0 "1,;'1~",1~r;;\( / '.oJ ',J ~:~" AnyClly,ST -""--"'006- ,~.F' Number' ~:~\:I,~li",,!,\:J1 r /;; ,}, w;it >".~~~~ii:~i~,,;<'~~j~91.!t'~R~~~; . ~1V'2~;>\!O, ,) , 'ii''': i .' /"ORM',P'N",St" .... ..' "');ri'~~C~Y$ \,OOOO;OOO2~ , 2~- -'" 1!--if"" ~ ."", v...... ".t' ':,,\S!:'. Pay To The >}XBC-.SUPPI.X , ,"; ,'::..;;0'''' .:~123~AUBURN\STREET Orde~?f ?~P,O.:lllIU;\ND,'Mf.IN~ Q410'1 _~ ~~~_ ~,: _~ _" .~;::~ I ~' ',' " " , ~~-~~.'-<~ .l&--=->n~,.;~....~~_'~~i.-..-.~~:"MP ,: , .~~. .' AUTHORIZED SIG~ATURE I '.. -, 010 ,\o;~.l~ .', i 11100 2 ~ ~~;~IS~'tiB~~I:O 25 20 ~ 7 2 ~ 2111 : ~ ..mU_.._...mm......_n.....m... .... ....... ......_ ..... .......__.,...___'...'m.h... ..'.m........___..m'mh...mnm..__..___ ... m...,. .,.. .....,.. ..00.__.......... "._...... ... m.............. _....m....___'-I I' I I .......:1 il ""''''1 -- -, 1 I I I .....mh'..." nmm__.. .. '-1 I I I I I , -I :l. --.I to.) ";'l ~ ,m'} , , Ii I L..~u. -j "See Reverse Side For Easy Opening Instructions" j-... , Your Organization P,O. Box 000 Any City, ST 00000 002110 PRESORTED FIRST.CLASS MAIL U.S, POSTAGE PAID PORTLAND, .ME PERMIT NO.4 , I I I I I I I I I I I I I I I I I FORMUNISN ADDRESS SERVICE REQUESTED 11I11I1111I11...111..11...1111.11...111111111.1111I1 ABC SUPPLY 123 AUBURN STREET PORTLAND, MAINE 04101 ,rr: REMOVE 80TH SIDE STUBS FIRST ,- FOLD, CREASE AND REMOVE THIS STUll AT PERFORATION " T ENDORSE CHECK HERE X______ T , , , , i*---- , , , , , , DO NOT WHITE i SIGN! STAMP BELOW THiS liNE r z 0 ~ '" 0 ... '" W l- I>. en < '" i:i: III en :::I C :;; Z w en :%: i: l- I- 0 w III > < 0 :E en w III '" :::I C I- en Z w <( > w 0 en :E <( w w '" '" U ci ... 0 ... Z w :%: I- l" , , , , , , , , , " , , , , , , , , , , , " , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , __ m}: -- - - l'- - - - - - - - - - - ,- - - - - - -- - - - - - - - - - - - - - - ,- ~ NOIIVlIO~1I3d IV srus SIHl 3^OW311 ONV 3SV311:> 'OlO~ ~, ISlIl~ sarus 30lS HI0S 3^OW311 - - l- - - - .- JL v DEPOSITORY BANK ENDORSEMENT ----r---- T II --..:t.----- J.. Incorporated Village of Formunis Dept. of Purchase 99 Any Court, P.O. Box 11 Any town, 5T 00000-0011 FOR M U N IS.. (111) 222-3333 Fax 111) 222-4444 Retain this purchase order for proof of tax exemption, Tax Exempt #11-6000000 V e n d o r ALLIED OFFICE PRODUCTS 1500 CENTRAL AVENUE ANYCITY, ST 11111-2222 ven~~r1 ~~;;~5~~;ber ven1g19~ _;;3~:6~:er Req~~~~~nO~~~ber 1- Date Ordered _Vendor Number Dat.~ _Requit:!ld" Freigt:!t. M~th.od/Ierms 06/10/00 000890 07/10/00 TRUCK Item# .. [)escriptionl.f>art_.Ng. _ , _, H_ . ~niVClty 001 EACH HON 7707 HIGH PERFORMANCE TASK CHAIR W/FABRIC #10 BLACK. PRICE CODE III 3.0 EA 002 EACH HON 7795 ADJUSTABLE HEIGHT ARMS 3.0 EA 003 2 SUPERIOR CHAIRS #1022 FABRIC # 1002 PLUS 1 SUPERIOR #1974 (PR. ADJUSTABLE ARMS) TO BE PICKED UP & RETURNED FOR FULL CREDIT AS PER JOSEPH PRESAMPIER. OUR PO#9911354. ALLIED INVOICE 5/20/00. CR. $617.00 1.0 EA ***** General Ledger Summary Section *** * Account A1410-220 Purchase Order Fiscal Year 2000 Page THIS NUMBER MUST APPEAR ON ALL INVOICES, PACKAGES AND SHIPPING PAPERS. Purchase Order # 20000704-03 Delivery must be made within doors of specified destination, S h i P T o VILLAGE CLERK VILLAGE OF FORMUNIS 99 ANY COURT ANYTOWN, ST 00000 Delivery Flefere"ce. MARY SMITH Cost Each _ . --- ._~ .... ----"' DepartITl_~l!tLlo~_atjon. .. CLERK'S OFFICE Extended Price _, .,_.'_~. ___ ,_n .,.~ .__, ",,_'w'_.,. 175.00000 525.00 37.50000 112.50 0.00000 0.00 PO Total 637.50 Amount 637.50 * Important: Read terms and conditions provided as part of this purchase order When complete shipment is made, mail your invoice itemizing all charges to: Accts, Payable Dept., 99 Any Court, P.O. Box 11, Any town, ST 00000 VENDOR COPY BY~O~ Call 800.451.1709 to reorder - Formunis POCS V.4. 1 Incorporated Village of Formunis THIS NUMBER MUST APPEAR ON ALL INVOICES, PACKAGES AND SHIPPING PAPERS. Purchase Order # 20000704-03 Address all acknowledgements and all communications relating to this order to the Department of Purchase, Incorporated Village of Formunis, 99 Any Court, Any town, ST 00000. Conditions Governing this Purchase Order 1. THE INCORPORATED VILLAGE OF FORMUNIS IS NOT RESPONSIBLE FOR MATERIALS, SUPPLIES OR EQUIPMENT DELIVERED WITHOUT AUTHORITY OF ITS WRITTEN ORDER. 2. Do not overship or substitute. Ship exactly as ordered, 3. All material shipped by freight, express or parcel post, MUST HAVE ALL CHARGES FULLY PREPAID TO POINT OF DELIVERY, unless otherwise arranged for and expressly stated on this order. Store-Door deliveries are not acceptable. 4. Include itemized packing slips with all shipments or deliveries. Show name of DEPARTMENT for whom delivery is intended. 5. Invoices must be rendered on enclosed claim form, on date of COMPLETE SHIPMENT of all materials on this order. Separate billing for partial shipments not allowed unless otherwise arranged for and expressly stated on this order. 6. Use separate claim form for each order. Claim must be itemized in detail. An itemized claim is one set forth in items and in such form that anyone reading same may readily understand the kind, quantity, quality and prices. 7. CASH DISCOUNT TERMS must be indicated on claim form. Time in connection with discount offered will be computed from date of delivery of the materials, equipment and/or supplies at destination, where final inspection and acceptance is made, or from date correct billing on Village claim form properly certified by the vendor or contractor is received in the office of Department of Purchase, if the latter date is later than the date of delivery. 8. All materials, supplies and equipment received subject to inspection and acceptance by Village of Formunis. 9. If unable to fill this order exactly in accordance with description unit and price thereon communicate at once with Department of Purchase for instructions. The Village reserves the right to reject and return at shipper's expense any and all materials or supplies delivered which do not conform to our description or specifications. 10. If there is any part of this order you cannot fill promptly or within the time specified, notify the Department of Purchase at once. In case of unreasonable delay in delivery or delivery of goods inferior to those specified, or in case of any other default of the vendor, the Department of Purchase shall have the right at it's option to cancel this order in whole or in part, and the Village may procure the goods, or services from other sources, and hold the vendor responsible for any part, and EXCESS COST, EXPENSE AND DAMAGES occasioned thereby. 11. The vendor by accepting this order agrees to assume the defense of and hold Village of Formunis, its agents and its employees, harmless from all suits, costs, expenses, claims and damages arising from the use of the described materials because of actual or alleged infringement of any copy rights, patent or patent right of any invention or any other cause, and vendor represents and warrants that the unit prices charged herein are not higher than any applicable legal maximum prices permitted under existing governmental regulations and are not in excess of those currently charged to other governmental, institutional, or commercial users for similar items, quantities and deliveries. 12. The workmanship, quantities or qualities of goods which are to be paid for hereunder shall be to the satisfaction of the Department of Purchase and before final acceptance by the Department of Purchase all matters of dispute must be adjusted to the mutual satisfaction of the Department of Purchase and the vendor. Determinations and decisions, in case any question shall arise, shall constitute a condition precedent to the right of the vendor to receive any money thereof, until the matter in question is settled. 13. Upon the vendor's acceptance hereof, the vendor agrees to comply with and shall comply with Art. 9 Sec. 10 of the Chapter 472 of the laws of 1922 being Sections 220, 220a and 220b, of the Labor Law and with Chapter 424 of the laws of 1950, Section 22e prohibiting discrimination on account of race, creed, color, or national origin in hiring employees within the State involved in the manufacture of materials, equipment or supplies specified herein, and with Section 5 and 12 of the Lien Law, and with Sec. 109 of the General Municipal Law as to assignment of contracts, and Sec. 108 of the General Municipal Law as to Workmen's Compensation and the vendor shall keep itself fully informed of all municipal ordinances and regulations, State and national Laws in any manner affecting this order and the goods delivered or to be delivered thereunder, and shall at all times observe and comply with said ordinances, laws and regulations at his sole cost and expense. 14. All items delivered on this order are to be new and the manufacture or product of the United States or its territorial possessions, unless otherwise specified. 15. EXCISE AND SALES TAXES: The prices herein should not include any Federal excise taxes or sales taxes imposed by any State or Municipal Government. Such taxes, if included, must be deducted by the vendor when submitting claim for payment. Incorporated Village of Formunis Dept. of Purchase 99 Any Court, P,O. Box 11 Any town, ST 00000-0011 FOR M U N I 5 ~ 1111) 222-3333 Fax 111) 222-4444 Retain this purchase order for proof of tax exemption. Tax Exempt #11-6000000 V e n d o r ALLIED OFFICE PRODUCTS 1500 CENTRAL AVENUE ANYCITY, ST 11111-2222 Vendor Phone Number Vendor Fax Number Requi~ition Number 111-333-6666 01410045 111-333-5555 Date Ordered Vendor Number Date Reqljired 06/10/00 000890 07/10/00 Freight Method/Terms TRUCK Item# Description/Part No. 001 EACH HON 7707 HIGH PERFORMANCE TASK CHAIR W/FABRIC #10 BLACK. PRICE CODE III 002 EACH HON 7795 ADJUSTABLE HEIGHT ARMS 003 2 SUPERIOR CHAIRS #1022 FABRIC # 1002 PLUS 1 SUPERIOR #1974 (PR. ADJUSTABLE ARMS) TO BE PICKED UP & RETURNED FOR FULL CREDIT AS PER JOSEPH PRESAMPIER. OUR PO#9911354. ALLIED INVOICE 5/20/00. CR. $617.00 ***** General Ledger Summary Section *** * Account A1410-220 Unit/Ow 3.0 EA 3.0 EA 1.0 EA Purchase Order Fiscal Year 2000 Page THIS NUMBER MUST APPEAR ON ALL INVOICES. PACKAGES AND SHIPPING PAPERS. Purchase Order # 20000704-03 Delivery must be made within doors of specified destination. S h i P T o VILLAGE CLERK VILLAGE OF FORMUNIS 99 ANY COURT ANYTOWN, ST 00000 Delivery Reference MARY SMITH Cost Each Department/Location CLERK'S OFFICE Extended Price 175.00000 525.00 37.50000 112.50 0.00000 0.00 po Total 637.50 Amount 637.50 * Important: Read terms and conditions provided as part of this purchase order When complete shipment is made, mail your invoice itemizing all charges to: Accts, Payable Dept., 99 Any Court, P,Q. Box 11, Any town, ST 00000 PURCHASING COPY BY~f~ Claim Voucher Incorporated Village of Formunis Dept. of Purchase 99 Any Court, P.O. Box 11 Any town, ST 00000 (111) 222-3333 Fax (111) 222-4444 This claim for one purchase order only V e n d o r ALLIED OFFICE PRODUCTS 1500 CENTRAL AVENUE ANYCITY, ST 11111-2222 >- ~ o liJ ~ liJ (!) <::( -.J ;:::! ::::> ct: ft Auditing Dept. Purchase Order Number: 20000704-03 Initial HprA Acct. Code Amount Data Entry Ini ial Here InvOice No. I hereby certify that the goods or services specified and enumerated above have been received or performed and that the quantities and Qualities thereof are in accordance with those ordered, ViII8Q8 Department Head Dala S h j' P T o VILLAGE CLERK VILLAGE OF FORMUNIS 99 ANY COURT ANYTOWN, ST 00000 - _.Y~n~~r1~;;;~5~~;ber ve~~1o~~~~x3~6u6~:~r R~qU~~!~~nO~:;ber 1--'-- Date Ordered ..Yend~>r Nurnber, "pateRequir_e.~L_ __.freig~! Me!h_o.(lJIerms.~.,_. ___ 06/10/00 000890 07/10/00 TRUCK ftem# _ D~_s_~riptlonIPClrt:~(). l:)elive.rY,l3l:lference MARY SMITH [)e.p,artment/Locatiol'l_. CLERK'S OFFICE ,_, ___ _ ~nitlClty _., Cost Each , Extended Price .,.-._-,-., ,._-~ -> .--_.. ...- 001 EACH HON 7707 HIGH PERFORMANCE TASK CHAIR W/FABRIC #10 BLACK. PRICE CODE III 3.0 EA 175.00000 525.00 002 EACH HON 7795 ADJUSTABLE HEIGHT ARMS 003 2 SUPERIOR CHAIRS #1022 FABRIC # 1002 PLUS 1 SUPERIOR #1974 (PR. ADJUSTABLE ARMS) TO BE PICKED UP & RETURNED FOR FULL CREDIT AS PER JOSEPH PRESAMPIER. OUR PO#9911354. ALLIED INVOICE 5/20/00. CR. $617.00 3.0 EA 37.50000 112.50 1.0 EA 0.00000 0.00 PO Total 637.50 ***** General Ledger Summary Section *** * Account A1410-220 Amount 637.50 Instructions: This copy is to be forwarded to the Accounting Department immediately upon receipt of the material or services ordered herein. Hold report of partial shipment until order is completed unless partial payment is to be made for incomplete order, In case material is damaged in transit or service is unsatisfactory, please make note of the extent of damage or reason for dissatisfaction on this receiving report. Use reverse side if necessary. \/~ LLZ{O::_ t~ J': t -~(~ ~~::}" ~ ;~J l' \1 J $ ~; ~,;2 C:~ 1{l ~~-{ ~f~ By CLAIM VOUCHER Incorporated Village of Formunis Dept, of Purchase 99 Any Court, P.O. Box 11 Any town, 5T 00000-0011 FO R M U N I S ~ (111) 222-3333 Fax 111) 222-4444 Retain this purchase order for proof of tax exemption. Tax Exempt #11-6000000 V e n d o r ALLIED OFFICE PRODUCTS 1500 CENTRAL AVENUE ANYCITY, ST 11111-2222 Vendor Phone Number 111-333-5555 Vendor Fax Number Requi~iti(m NUl}lber 111-333-6666 01410045 Date Ordered Vendor Number . Date Requjr,ed 000890 07/10/00 Freight Method/Terms TRUCK 06/10/00 Item# Description/Part No. , 001 EACH HON 7707 HIGH PERFORMANCE TASK CHAIR W/FABRIC #10 BLACK. PRICE CODE III 002 EACH HON 7795 ADJUSTABLE HEIGHT ARMS 003 2 SUPERIOR CHAIRS #1022 FABRIC # 1002 PLUS 1 SUPERIOR #1974 (PR. ADJUSTABLE ARMS) TO BE PICKED UP & RETURNED FOR FULL CREDIT AS PER JOSEPH PRESAMPIER. OUR PO#9911354. ALLIED INVOICE 5/20/00. CR. $617.00 ***** General Ledger Summary Section *** * Account A1410-220 Invoice Date _1_1_ Invoice Amount $ AccountinQ Dept. Numerical File Copy Date invoice will be paid 1_1- ACCOUNTING COPY Unil/~!Y 3.0 EA 3.0 EA 1.0 EA Purchase Order Fiscal Year 2000 Page 1 THIS NUMBER MUST APPEAR ON ALL INVOICES, PACKAGES AND SHIPPING PAPERS. Purchase Order # 20000704-03 S h I P T o Delivery must be made within doors of specified destination. VILLAGE CLERK VILLAGE OF FORMUNIS 99 ANY COURT ANYTOWN, ST 00000 Delivery Reference MARY SMITH Cost Each Department/Location CLERK'S OFFICE Extended Price 175.00000 525.00 37.50000 112.50 0.00000 0.00 PO Total 637.50 Amount 637.50 By C\n .Il · ~ . ~- :.;l-h n Director of Purchasing INVOICE ATTN: Accounts Receivable 123 Any Street Any City. ST 00000 Invoice Date Invoice No. - , _._- ,.-, .- - - 03/22/2000 7985 Customer Number -- -. ._.,~_. _ .....n.'_..~__ ..-.--. 20020 FORMUNISrM Kensington County Attn: Ashley Cunningham 2nd & West Streets Greenville NY19704 111...1111111...11...11...11'1111"1111..11...1111I1 Description OrigBill Adjusted Paid Amount Due BCBS INDIVIDUAL EMPLOYER CONTRIBUTION 802.30 .00 .00 802.30 QTY 5.00 @ 160.46 PER EACH BCBS FAMILY EMPLOYER CONTRIBUTION 1816.85 .00 .00 1816.85 QTY 5,00 @ 363.37 PER EACH PHP INDIVIDUAL EMPLOYER CONTRIBUTION 796.70 .00 .00 796.70 QTY 5.00 @ 159.34 PER EACH HMO INDIVIDUAL EMPLOYER CONTRIBUTION 678.25 .00 .00 678.25 QTY 5.00 @ 135.65 PER EACH BCBS EXT-20 IND EMPLOYER CONTRIBUTION 517.90 .00 .00 517.90 QTY 5.00 @ 103.58 PER EACH BCBS EXT-20 DEP. EMPLOYER 490.65 .00 .00 490.65 CONTRIBUTION QTY 5.00 @ 98.13 PER EACH ***** G/L Org A084860 A084861 A084862 Account Summary ***** Object Project 80 80 80 Amount 4,094.10 517.90 490.65 , DUE 03/31/00 II INVOICE TOTAL DUE 5,199.60 THIS IS YOUR QUARTERLY PREMIUM DUE FOR 3/1/00 TO 5/31/00. CALL JANE DOE @ 555-1212 IF YOU HAVE QUESTIONS. MAKE CHECKS PAYABLE TO GBF INFOSYSTEMS. Call 800.451.1709 to reorder - Formunis INVCS V.4.1 STATEMENT FORMUNISTM Invoice Date 11/22/2000 Customer Number 20020 ATTN: Accounts Receivable 123 Any Street Any City, ST 00000 THIS IS A REMINDER THA T THE INVOICES LISTED BELOW ARE NOW PAST DUE. PLEASE REMIT PROMPTL Y. CALL JOHN DOE A T 555-1212 IF YOU HA VE QUESTIONS. RETURN ONE COPY OF STA TEMENT WITH YOUR PA YMENT. THANK YOu. Kensington County Attn: Ashley Cunningham 2nd & West Streets Greenville NY 19704 I" III" III" 11111...11,1111,11111,," III" 11.1111.1 Description Invoice' Date Bill Amount Bill Adjusted Paid Balance Due Supplies 878 03/13/00 426274.00 -170491.31 197781.49 58001.20 Consultation 6226 06/30/00 515000.00 .00 128750.00 386250.00 Printers 6328 06/30/00 93888.50 .00 .00 93888.50 Software 6804 10/20/00 1057.89 .00 .00 1057.89 1-30 DAYS 1057.89 31-60 DAYS .00 61-90 DAYS .00 OVER 90 DAYS 538139.70 OTHER FEE .00 TOTAL DUE 539197.59 Call 800.451.1709 to reorder - Formunis STMCS V.4. 1 * * * Form W-2 Waoe and Tax Statement 2000 0, Department of the Treasurv - Internal Revenue Service Copy B To Be Filed With Employee's FEDERAL Tax Return 1 Wages, tips, other comp, 2 Federal income tax withheld This information is being fumished to the Internal Revenue Service, 120.00 Employer's name. address, and ZIP code Employer I,D, number 3 Social security wages 4 Social security tax withheld MUNIS TEST SYSTEM 12-3456789 120,00 7.44 100 MAIN STREET Employee's social security number 5 Medicare wages and tips 6 Medicare tax withheld NEWBURYPORT, MA 04105-9999 444-44-4444 120.00 1,74 7 Social security tips 8 Allocated lips 9 Advance EIC payment Employee's name, address. and ZIP code 10 Dependent care benefits 13 See instrs. for box 13 14 Other DOE, JANE 11 Nonqualified plans 54 BLUEGill DRIVE KNOXVillE, TN 67802 12 Benefits included in box 1 15 Stat, emp, I Deceased I pens~ plan Legal rep. " Deferred comp, 16 Slale I Employer's state 1.0, no, 117 Slate wages, tips. etc, 118 State income tax 119 Locality name 120 Local wages, tips, ete, 21 Local income tax MA 2100121 120.00 7.20 ..,..,.,. ...... ... ....-. OMB N 15450008 ..... C (1) E c ... (1) > o C) Form W-2 Waae and Tax Statement 2000 OMB No, 1545-0008 Department of the Treasurv -- Internal Revenue Service Copy C For EMPLOYEE'S RECORDS (See Notice to Employee on back of Copy B,) 1 w1\es, t~s, other compo Federal income tax withheld This information is being furnished to the Internal Revenue Service, 1 0.0 Employer's name, address, and ZIP code Employer 1.0, number 3 Social security wages 4 Social security tax withheld MUNIS TEST SYSTEM 12-3456789 120,00 7.44 100 MAIN STREET EmgtOyee'S social security number 5 Medicare wages and tips 6 Medicare lax wilhheld NEWBURYPORT, MA 04105-9999 4 4-44-4444 120.00 1.74 7 Social security lips 8 Allocated tips 9 Advance EIC payment Employee's name. address, and ZIP code 10 Dependent care benefits 13 See instrs, for box 13 14 Other DOE, JANE 11 Nonqualified plans 54 BLUEGill DRIVE KNOXVilLE, TN 67802 12 Benefits included in box 1 15 Stat, emp, I Deceased I pensX' plan Legal rep, I Deferred comp, 16 Stale I Employer's state 1.0, no, 117 State wages, tips, etc, 118 State income tax 119 Locality name 120 Local wages, lips, etc, 21 Local income tax MA 2100121 120.00 7.20 '" :> III t) N :s: co ... (1) "C (1) u.. (1) .J: ..... .J: .~ 3: C) c In '1: ::> E o u.. :;; '0 o Q) 0: S '" o .... .- - n nCO .- "C (1) E (,) +: (1) c C) CO E to <t 8 IX) ro t) OMB No, 1545-0008 Copy 2 To Be Filed With Employee's State, City, or Local Income Tax Return De artment of the Treasu -. Internal Revenue Service 1 Wages, lips. other comp, Federal income lax withheld 120,00 Employer's name. address, and ZIP code MUNIS TEST SYSTEM 100 MAIN STREET NEWBURYPORT, MA 04105-9999 Employer I,D, number 12-3456789 3 Social security wages 120,00 4 Social security tax withheld 7.44 Employee's social security number 5 Medicare wages and tips 444-44-4444 120,00 7 Social securily tips 8 Allocated lips 6 Medicare tax withheld 1,74 9 Advance EIC payment rn (1) ... Employee'S name, address. and ZIP code 10 Dependent care benefits 13 See instrs. for box 13 14 Other ~ C' (1) ... DOE, JANE 54 BLUEGill DRIVE KNOXVillE, TN 67802 11 Nonqualified plans 12 Benefits included in box 1 E ... o - rn .- .J: I- * * * 16 State Employer's state I,D, no. MA 2100121 17 State wages, tips, etc, 120,00 18 State income tax 7.20 19 Locality name Legal rep, Deferred compo 21 Local income lax Form W-2 Waoe and Tax Statement 2000 0, Department of the Treasurv -- Internal Revenue Service Copy 2 To Be Filed With Employee's State, City, or 1 Wages, lips, other comp, j2 Federal income tax wilhheld Local Income Tax Return 120.00 Employer's name, address, and ZIP code Employer 1.0. number 3 Social security wages 4 Social securily tax withheld MUNIS TEST SYSTEM 12-3456789 120,00 7.44 100 MAIN STREET Employee's social security number 5 Medicare wages and tips 6 Medicare tax withheld NEWBURYPORT, MA 04105-9999 444-44-4444 120.00 1.74 7 Social security tips 8 Allocated lips 9 Advance EIC payment Employee's name, address. and ZIP code 10 Dependent care benefits 13 See instrs, for box 13 14 Other DOE, JANE 11 Nonqualified plans 54 BLUEGill DRIVE KNOXVillE, TN 67802 12 Benefits included in box 1 15 Stat, emp, I Deceased I pens~ plan Legal rep, I Deferred comp, 16 State I Employer's stale I.D. no, 117 State wages, tips, etc, 118 State income tax r 9 Locality name 120 Local wages, tips, etc, 21 Local income tax MA 21 001 21 120.00 7.20 OMB N 1545-0008 lXl o C\I Ll) Notice to Employee Refund, Even if you do not have to file a tax return, you should file to get a refund if box 2 shows Federal income tax withheld, or if you can take the eamed income credit. Earned income credit (EIC), You must file a tax return if any amount'is shown in box 9, You may be able to take the EIC for 2000 if (1) you do not have a qualifying child and you earned less than $10,380, (2) you have one qualifying child and you earned less than $27,413, or (3) you have more than one qualifYing child and you eamed less than $31.152. You and any qualifying children must have valid social security numbers (SSNs), You cannot claim the EfC if your Investment income is more than $2.400, Any EIC that is more than your tax liability is refunded to you, but only If you file a tax return, If you have at least one queJifying child, you may get as much as $1,412 of the EIC in advance by completing Form W-5, Earned Income Credit Advance Payment Certificate. Clergy and religious workers. If you are not subject to social Box 1, Enler lhis amount on !he W'olgeS lJ1e of you" taX rolurn, Box 2. Erler this arnoom on the Federal ~ tax ~hheld line 01 your lax ralum. Box 8, Tljsamount is not ilcIuded in boxes 1,3.5, or7. Fat information on now to report tip50n your tax return. see your Form 1040 instN::tIons. Bor 9, Erter It.is amount on the sdl/aflCEl eamOO income cred. paymen1s firu~ of YOl.If FOffi'1 1040 Of 104M, eox 10. This amol.Ji1 is the lotaI deperdent care benet45 YOO1 ~r paid 10 you 01 incl.rred on you behalf (inclucing amounts from a sedion 125 (cafeteria) pl.an~ Arty amourt CNer $5.000 also is inclOOed in box 1. You must c~te Schodukl2 (Form 1 040A) Of Form 2441. Child and DP-pendent Care Expenses. 10 canpute arr; la:xabta and nonlaxatie amounts. Box 11, ihis 8l'T'()tJI11 is {a) t~edin box 1 it it i9 a listrbJtion made to you from a nonqua~fied delerred COl'I"f)OOsation Of section 457 plan or (b) muded in box 3 and/or 5 if it is 8 pOOr year deromlJ :.:nder a ncnq.lalifled or S0Clioo 457 plan that became taxable lor social6eC~ and f\.-tedicate taxes this year because there is no longer a substantial riask of forfeiture of your rigtllo the dGierred amounl. I Box 12. This amoUlt i5lhe taxable tringebeMfitG rooded in box 1. You rnay be able to dedixt expenseslhal are relaJed 10 lriri,ge benclits; see the Form 1040 instrmbons. 80113, Thefollowng li&te~""thacode, shown in box 13. 'too may needt~ information 10 complete yoor lax return. Nelt: if. yesr IoPows code D.E. F. G, H. or S. you 1TllJde Of make-tp pension contriburioo to! a fXior Y6ar(s) Vt'hen}'Ol1 W9I"O in mltsry service. To 6gl./r9 v;herher you made exc8$$ dsltHT8fs, consider these amounts lor the year sho..m, nol rh6 current yetJ!. fI no }'6iJ.f is shown, the cantmcAions are for the Currmt,jWl. A. Uncollected strial soculty or RHTA tax ontPs (lndude1hi6 tml; on Form HMO. See 'TOCal Talt" in the Form 1040 ins'.ructions.) a. Unconected Mecicare lax on l~ (fnc;ludethis tax on Form 1040. See "Tocal Tax- in the Form 1040 instructions.) C . Cost of g~n lie insurarcc l1tIer $50.000 (irdlXled in boxes 1, 3(lp to social securiy wage base), and 5) O. ElaclNe dolerra'" 10. sect~n 401(1<) cash or dol.Hed .'rangemern, AIoo includes deferral. under a SIMPLE retirerrtefi 80C0Uri that: i&c part of a sectioo 401(k) arrangement E . ElocIive delerrals under a section 403(b) salary fecltxtion agr&elTlef1. security and Medicare taxes, see Pub, 517, Social Security and Other Information for Members of the Clergy and Religious Walkers, Corre<:tions, If your name, SSN. or address Is incorrect, correct Copies B, C, and 2 and ask your employer to correct your employment record, Be sure to ask the employer to file Form W-2c, Corrected Wage and Tax Statement. with the Social Security Administration (SSA) to correct any name, SSN, or money amount error reported to Ihe SSA on Form W.2. If your name and SSN are correct but are not the same as shown on your social security card, you should ask for a new card at any SSA office or call 1-800-772-1213, Credit for excess taxes. If you had more than one employer in 2000 and more than $4,724.40 in social security and/orlier 1 railroad retirement (RRTA) taxes were withheld. you may be able to claim a credit for the excess against your Federal income tax, if you had more than one railroad employer and more than $2,778,30 in lier 2 RRTA tax was withheld, you also may be abie to claim a credit. See your Form 1040 or 1 040A instructions and Pub. 50S, Tax Withholding and Estimated Tax. F. EIed". 001"",,1< Lrlder. section 408(k)(6) .wary rodI.<1ion SEP, G ~ Elective and nonelective deferrals 10 0 sootion 457(b) deferred c~nsatioo plan H ~ Elediw deferrals to a saction 501 (c)(18)(O) tax-exentfX Ol'garJzation plan (see ~AdJUSled Gross Income" tnthe Form 1040iT\'itruclions lor how to dedld). J - Nontaxable ,ick pay (not included in box 1, 3. 0' 5). K. 2O"r. exciset8.lt on axcess gotdenparachute payments (see "'Total Tax. in the Form 1040 insUuctions) L - Stilstantiated efll)Ioyee business expense reirroursemtmts: {noolaxable). M. U~ social security or RATA tax on cost of gro\.~.term lite insurance O'l/E-lr $50,000 (Ioone! .rrPoi- only) (see "T...I T.... in !h. Form 1040 i1strudions), H . U~ed Medic&re II\)( on cost of gro\.4)~errn fila in.';Ul'srce r.:Nef $50.000 (IOfmer efTl)lOYOO6 only) (500 "T~l Tax" in lhe Form 1040 instructions) P . ~ tl10Ying e:q>ens8 reirblrseroonts paid diredly to erJll!oyoo (not ircluded in baltes 1. 3,0<6). Q - Military employee basic housi....g, subsistence. and coobat zone C'Of1'l>el1S8tJOl1 (use this amounl ~ you qualfy lot EIC), R a ~er contrWions to your medical ~s ilOCOUT1l (MSAl (see Fann 8853, Medeal S8vings Aa:ount& Bnd Long-Term Care InslJ"ance Coftracls). S. ~ salary redu::tion contriOOtions under a section 408(P) SIMPLE (no! in::luded in box I), T -Adoption benefits (not irdJded i'I box 1), You IYU!>I c~te Form 8839, Qualified Adoption Expenses. 10 t:01'!1>lJe any ~ and nontaxable a:rnol..rls. Box 15. If the ~Pension plan- box is checked. special ijmi!s may ~ to 1M amount 01 traditional IRA cor4rbutions yoo may dedtd.. If the "Deferred c~tion" box is checked, the elfx:tive deferrals i1 box 13 (codes D.E,F,G,H, and S) (lOf aU en~Ioye~. and fQf aU such plans 10 whdl you belong) nre generally lirnil.ed to $10.500. Elective delerrals lor section 403(b) conlrac!nre limited 10$10,500 ($t3,5OO in some cases-; see Pm. 571). The IirnfilOf section 4S7(b) plans L'l $8,()(X) Amoonts OYeIlheoo timils mJSt hf'l irduded in income. See 'Wages, Salaries, TIpl5. etc: in the Form 1040 instnUions. . Net.: Keep CGl>r C 01 Fotm 11'2 for ..least 3 )'08IS 8ft"' the dUll cial. for fling yo;v ,,,.co,,,,, lax flllum, 110....""" to heI> proIscI your '0<;'1 ucurity """"fits. koep CGl>r C un" yoo beg" receiving social secur4y bone/~s, ~ in C8Se there is a questioo about yot.r wor'I< recOld oncfor earnings in a priuJar year. The SSA suggests)OI.J con5rm your I40rk record with them from lime to time. OVOID o CORRECTED PAYER'S name, street address, city, slate, Zip code, and telephone no. 1 Rents OMB No, 1545-0115 YOUR ORGANIZATION $ 100 ANY STREET 2 Royallies 2000 Miscellaneous ANY CITY, ST 00000-9999 $ Income 3 Other income (800) 451-1709 $ FORM 1099-MISC PAYER'S Federal identification number I RECIPIENT'S identification number 4 Federal income tax withheld 5 Fishing boat proceeds Copy B 12-3456789 547-24-2467 $ $ For Recipient RECIPIENT'S name, street address, city, state, and Zip code 6 Medical and health care payments 7 Nonemployee compensation 1111111111111111111111111111111111111111111111111111 $57681.00 $ This is important tax informalion and is COMPUTER STORE 8 Subslilute payments in lieu of 9 Payer made direct sales of being furnished to the dividends or interest $5,000 or more of consumer Internal Revenue 1 MALL ROAD products to a buyer ~ ~~' If you are (recipient) for resale D SOUTH PORTLAND ME 04102 $ requi file a return, 10 Crop insurance proceeds 11 Slate income tax withheld a nce penally or ~ sanction may be $ $ , osed on you if this Account number (optional) 12nool. 12 State/Payer's state number 13 ~ Income is taxable and i the IRS determines that $ $ ~' it has not been reported, F rm 1099-MISC Department of ~asury - Internal Revenue Service o ~ 'U un.. ~mu ~'V ~~ OMB N~ 0115 ~boo OVOID o CORRECTED <i :> (f) u ::2; '" '" o PAYER'S name, street address, city, slate, Zip code, and telephone no, YOUR ORGANIZATION 1 00 ANY STREET ANY CITY, ST 00000-9999 $ 1 Rents $ 2 Royallies 3 Other income (800) 451-1709 $ FORM 1099-MISC 5 Fishing boal proceeds (I) 'c: " E (; lL PAYER'S Federal identification number 12-3456789 RECIPIENT'S identification number 547-24-2467 $ RECIPIENTS name. street address, city. slate, and Zip code 111...11...11...11...111..11"111...11...11...11,"1 COMPUTER STORE 1 MALL ROAD SOUTH PORTLAND ME 04102 7 Nonemployee compensation Oi '0 (; ~ E OJ o .... $ 9 Payer made direct sales of $5,000 or more of consumer products to a buyer .. (recipient) for resale'" D It) <t 8 co ;;; U 11 Slate income lax withheld Account number (optional) $ 13 $ $ Department Of the Treasury. Internal Revenue Service Form 1099-MISC ~ .nun_ ~... ~O'vm o V I~ 0 CORRECTED 1 Rents OMB No,l545-0115 $ 2000 2 Royallies $ 3 Other income $ FORM 1099-MISC 5 Fishing boat proceeds RECIPIENTS identification number 547-24-2467 4 Federal income lax withheld $ $ 6 Medical and health care paymenls 7 Nonemployee compensation $57681.00 ...11...11...11...11...11...1 COMPU TORE 1 MALL ROAD SOUTH PORTLAND ME 04102 $ 8 Substitute payments in tieu of dividends or interest 9 Payer made direcl sales of $5,000 or more of consumer products 10 a buyer .. (recipient) for resale'" D $ 10 Crop insurance proceeds 11 State income tax withheld $ $ 13 Account number (optional) 12 Slate/Payer's state number CJ $ $ Department of the Treasury - Internal Revenue Service Form 1099-MISC Miscellaneous Income Copy C For Payer or State Copy For Privacy Act and Paperwork Reduction Act Notice, see the 2000 General Instructions for Forms 1099, 1098, 5498, and W-2G. Miscellaneous Income Copy C For Payer or State Copy For Privacy Act and Paperwork Reduction Act Notice, see the 2000 General Instructions for Forms 1099, 1098, 5498, and W-2G. o CORRECTED (if checked) D' 'b . F * * * ..... c: Q) E c: ... Q) :> o C) PA YER'S name, street address, city, state, and ZIP code 1 Gross distribution OMS No, 1545-0119 Istn utlons rom Pensions, Annuities, YOUR ORGANIZATION $ 4258.99 Retirement or Profit-Sharing 100 ANY STREET 2a Taxable amount 2000 Plans, IRAs, ANY CITY, ST 00000-9999 Insurance $ 4258.99 Form 1099R Contracts, etc. (800) 451-1709 2b Taxable amount Total Copy B not determined D distribution D Report this income on your Federal tax PA YER'S Federal identification RECIPIENT'S identification 3 Ca~ital gain (included in 4 Federal income tax return. If this form number number box a) withheld shows Federal income tax withheld 1 0-4444444 01 0-00-1111 $ $ in box 4, attach this CODvtO vour return. RECIPIENT'S name, address, and ZIP code 5 Employee contri.butions 6 Net unrealized or Insurance premiums appreciation in "I..." ..." 111"'11" ,1111,1111..." III" III" 1111 employer's securities JOHN DOE $ $ This information is 123 ANY STREET 7 Distribution IRAI 8 Other being furnished to code SEPf the Internal ANY CITY, ST 00000 SIMPLE Revenue Service, 7 D $ % 9a Your percentage of 9 b Total employee contributions tnt,,' o/c $ Account number (optional) 10 State tax withheld 11 State/Payer's state no. 12 State distribution .$................................._.............._................ ....................................................................... $ $ '$......_........................._."_........... ! 3 Local tax withheld 14 Name of locality ! 5 Local distribution ..................................................................... ...................................................................... $................................................... $ .. > Ul u a: en en o VI 'E ::> E (; u. Q; '0 (; e 8 en o ,... ('C ... Q) 'C Q) LL. Q) .c ..... .c .'!: ~ C') c: Form 1099R Ii) " o o ro <ij U (Keep for your records.) Department of the Treasury.. Internal Revenue Service 't= ('Con 'C Q) E CJ '';: Q) c: C') ('C E rn Q) ... PA YER'S name, street address, city, state, and ZIP code 1 Gross distribution OMS No, 1545.0119 Distributions From Pensions, Annuities, YOUR ORGANIZATION $ 18963,60 Retirement or Profit-Sharing 100 ANY STREET 2a Taxable amount 2000 Plans, IRAs, ANY CITY, ST 00000-9999 Insurance $ 18963.60 Form 1099R Contracts, etc. (800) 451-1709 2b Taxable amount Total Copy C not determined D distribution D For Recipient's PA YER'S Federal identification RECIPIENT'S identification 3 Ca~ital gain (included in 4 Federal income tax Records and/or number number box a) withheld State, City or local 1 0-4444444 01 0-00-1111 $ $ 2400.00 Tax Department RECIPIENT'S name, address, and ZIP code 5 Employee contributions 6 Net unrealized or insurance premiums appreciation in "I..." III" ..1".11" III" ..1" ...1111I" 11.11...1 employer's securities JOHN DOE $ $ This information is 1 23 ANY STREET 7 Distribution IRAI 8 Other being furnished to code SEP/ the Internal ANY CITY, ST 00000 SIMPLE Revenue Service. 7 D $ % 9a Your percentage of 9b Total employee contributions Itnt,,' . i o/c $ Account number (optional) 10 State tax withheld 11 StatelPayer's state no. 12 State distribution .$................. -...-.........-............. ................... ....................................................................... $ $ '$................................................... ! 3 Local tax withheld 14 Name of locality ! 5 Local distribution ..................................................................... .............-....................................................... $..................................................' $ o CORRECTED (if checked) ~ C' Q) ... E ... o ..... en .- .c .... * * * Form 1099R (Keep for your records.) Department of the Treasury.. Internal Revenue Service ~rsovl:K1 Your Organization Name Here Any Street Any City, ST 00000 FORMUNIS", Address Service Requested .' __ ~.FE~!:l.~~mb~~,_, E-3-140-004 Int!l!e~U~~,gl~~ 12/22/99 WATER & SEWER BILL Remit Copy Please write your account number on your check and enclose this portion of bill with your payment. Make checks payable to; Your Organization .J".a~~D...u~I,r:!~!_~s.!.. !'.!.!r:!~il?_a.' .,~.as"t_ Du!. Cu~rent C~C!!:ges ,00 ,00 221.44 . . A FORMUNIS~ Your Organization 1 23 Any Street Any City, ST 00000 $221.44 E-3-140-004 JOHN DOE JANE DOE 789 ANY STREET PO BOX 999 ANY CITY. ST 00000 111.11111.1..11111111.1.11111..1...11..1.1.111I1.1.1 Please Note Address Correction Below: Name Street City State Zip 0000000000006042000800040600900000221440 A FORMUNIS~ Your Organization 123 Any Street Any City, ST 00000 WATER & SEWER BILL <i ;> w .. Vi u co :J '" 'e :> E 15 u. . --- ,.---..---..--Jg~S~9.g~~-----------,:,-'--'--,..-.~:.....--1----------"~---- Service Address ..-....-." --'--'---'-"-"',.-' "~"'-"---'------'---'-'-~-- 789 ANY STREET _."._,~Nur.nl;!~_ ---1----.....- ----..---.A~=~~~~_~~1eL,-_.-_-- ---I---'-----lnt~;~~~1i2!nL-----I------..- . Bill Ql!t.l:l___,__ __ .__. - 40600 1 1/23/99 _ ..__,p_e~c:riR.t.Lo.':l..._. .,frl:l~'!t_f!e2.Q_.Q~~_ ~.erl:lYi.9.IJ.~,..B_e.l!dJ2.?..!.e...,_ f.'!.l:l~!lnL~ll!L. Reajling_ J'revi()us M~t.~f!!'l_a"9jn9.. ._~~~~g'J.lf~~t'~_._ _,____Qarg.!L___ REGS58 64 83.20 REGW58 08/24/1999 OS/27/1999 2912 2848 64 138,24 Last p..l:iyment A rTl~ Last PaymenlQl!t!'l f'!ir:H~il?aIJ'ast plJe_ Past D,lJe:lnlere.s! G.urr~nt Ghl!rges -,.. . . . - -- ... .. ,- .00 NO HISTORY ,00 ,00 221 .44 $221.44 . Customer Copy Keep this portion for your records lU '0 15 ~ 9 en o ... '" .. g co ro u - - - -----. - ~ COMMENT L1NEN1 * *...... *............. * ***-.--.-.--;-. -11-...... * * * *...... *.... * * *... * * * * ...-* * *... * * COMMENT LINE#2"''''''''''''''''''''''''''''''' * ... ... ... *...... *... ............ * * . * ... * * * * ... *... * *......... *... * *... COMMENT LINE#3 * ... ... *...... * *... * ... ........................... ... *.............................. * ... ..................... ... * ...... * COMMENT LINE#4'" ...... ...... ... ... ... ... ...... *... *..................... .............................. ... ... ... ... *......... ... ... ...... *... ... If you are mailing payment only. mail to: Your Organization P,O, Box 111 Any City, ST 00000 BILL IS DUE UPON PRESENTATION For all correspondence or payment in person: Your Organization 123 Any Street Any City. ST 00000 Subject to interest & suspension of service if not paid within 30 days of billing date, Interest: 8% per annum on total of arrears up to $1,500,00 18% per annum on total amount of arrears greater than $1,500.00 Bad Check Charge: $20.00 per account Office Hours: 8:30AM to 4:30PM Monday through Friday Phones: 1 (222) 222-2222 Daytime Phone 1 (888) 888-8888 Off Hour Emergencies KEEP LEAD FREE.............FLUSH TAP DAILY! 100 CU. FT. = 748 Gallons Rate per 100 cubic feet. Consumption billed in hundreds of cubic feet. Non-receipt of issued bill not deemed excuse for failure to pay, Property owner responsible for protection of meter from loss and from hot water. freezing or other damage. Any person other than an employee of this Water Company who turns water off or on at curb cock. without permission, is liable to a fine. ' From: Place First Class Stamp Here D Check here if change of address 11111I111.1" ".1,"" .1..11,,"1"1" 111.1.." .1..1 Your Organization P.O. Box 111 Any City, ST 00000-0000 " a----- SVTId ......... I J -;,/ Ii if THIS IS YOUR NEW2.WAY ENVELOPE HELP CONSERVE NATURAL RESOURCES ' ENERGY' PAPER '1.A1tDRJ.I.S '\ ! '1 \ " \ \ \ \ If' , II I: I: I r I: II I: I: II I: I I; II r I II' II II ~ fJ Q) LIFT FLAP GENTLY fJ ~ PULL PANEL DOWN ALONG PERFORATIONS FOR RETURN ENVELOPE IIIII r::?J 'I :1 ,I I :1 II I I I *See Reverse Side For Opening Instructions* Your Organization : P.O. Box 000 Any City, ST 00000-0000 PRESORTED FIRST-CLASS MAIL U,S. POSTAGE PAID 1 OUNCE YOUR STATE PERMIT NO, 1 FORMUNIS", Address Service Requested I I I I I I I I I I I I I 'Any Town, USA 55555-1111 J- - - - - - - - _. -- - - - - -- - - - - -- - - I I I I I I I i 111'1111"111"11111I11".1111I1"1.1,"11"1.1'1111 John Doe Jane Doe P.O. Box 999 Any Street ~ FORMUNIS- Your Organization 456 Any Street Any Town, ST 00000 Utility Bill Keep this portion for your records Customer & Location Description Account Number 12345678987654321 Meter Reading Present Due Date 12/01/00 Usage Charge SEWER WATER FIRE Pa!!t Due 41 .46 4565 8912 4463 8500 102 412 12.72 68,74 10.00 , Cl!rrerlt_Cha~ges 91.46 t . 133.55 ........................................ 11''''''' '* -LINE l'1ESSAGE AREA." *** **..... **.. ** *** **.'*...... .. *............................................ --LINE MESSAGE AREA- *....... "'........ "':.... 1<""" *............... ........ **.........................,....... **.. -LINE MESSAGE AREA-"""'''''''' *.... '*............................ *.. .................................................. *..... -LINE MESSAGE AREA-"""""''''''''' **........... "'.......... '*.. ~ FORMUNIS- Your Organization 456 Any Street Any Town, ST 00000 Utility Bill Keep this portion for your records Customer & Location Description Account NumbElI 12345678987654321 Meter Reading ____ _~r_~~~n! Due Date 12/01/00 Usage Charge SEWER WATER FIRE Past Due 41 .46 4565 8912 4463 8500 102 412 12,72 68,74 10.00 Current Charges 91 .46 t . 133.55 ****.*...****.******...***LlNE 1 MESSAGE AREA--.....-.------.-----..-. -*******************"'**"'**LlNE 2 MESSAGE AREA---.--------------...---- .* ****.. ********** ****** ---LINE MESSAGE AREA- **.......... **.. ***.**** **'*.... .. ******........ **............ .LINE 4 MESSAGE AREA............................ I:-' ru lJJ ~ In cr ~ []:> ~ []:> ~ cr In ~ lJJ ru I:-' CJ CJ I:-' lJJ lJJ In In I:-' ru CJ I:-' CJ CJ CJ CJ }>'1l'-(...(... ~ )> ~ ~9~~~ ~ ::J N 0 -1co)>mz -< W ~ OOZOo S -1)>0 :iEX-<Oo /;;" o ::J ~ ,Z8~mm " :iE-<cc UlO:D ~, ? ~~. -i ~ (Jl~ N ~ -i " -I~ '" ! .... s: 0.... o' 0 0 ::J '" 0 ~ 0 iil 0 ~ ~ " ~ Nl? ~ 0(1) ~ FORMUNIS_ Your Organization 456 Any Street Any Town, ST 00000 Utility Bill Keep this portion for your records Customer & Location Description AccQunt Number 12345678987654321 Meter Reading Present Due Date 12/01/00 Usage Charge '~ I FORMUNIS- 4565 8912 4463 8500 102 412 12,72 68,74 10.00 SEWER WATER FIRE Past Due 41 .46 c.urrent Ch~rge.s.. 91 .46 t . 133.55 .*******************.*****LINE 1 MESSAGE AREA*******..**..**..****.*** i ...........................LINE 2 MESSAGE AREA.......................... ................. * * '* '* '*.... .LINE MESSAGE AREA. '*................ *. *.... ....... '*... *......... '*... .LINE 4 MESSAGE AREA..... ............ ........ I:-' ru lJJ ~ In cr ~ []:> ~ []:> ~ cr In ~ lJJ ru I:-' CJ CJ I:-' lJJ lJJ In In I:-' ru CJ I:-' CJ CJ }>\J'-L..L. ~ )> ~ ~p~~~ ~ ::J N 0 -1co:t>mz :; -< W c OOZOO S -I)>; :iEX-<OO ... o ::J ~ Zocnmm " :E-<CC , o-i ~ ? ~ 2. UlO:D -i ~ g- o -i " (Jl ;;; N 0 !. -I ~ ~ 8 0 o' 0 s 0 ::J '" 0 ~ 0 iil 0 ~ ~ " .. ~ 0 ~tC 0<1> ~'O )> o~ C'l 0 C() 2 _____ c: e =-. a S?I z ,)> '< c ~'3 3 w;o ~ 0' w:c = ~ c.n'a "':-0 'c Your Organization 456 Any Street Any Town, ST 00000 Utility Bill Keep this portion for your records Customer & Location Description AC;C;QlJnt Numl>ElL 12345678987654321 Meter Reading - . --~!~,~~!:!~_.,-, -- _. Due Date. 12/01/00 Usage Charge SEWER WATER FIRE Past Due. 41 .46 4565 8912 4463 8500 102 412 12.72 68.74 10.00 ClJrrent Charg~s 91.46 t . 133.55 .**.***'*.'***'**~'*'****......LINE .**...........~.*.******...LINE 't:...... *............... *... *.LINF. MESSAGE AREA.. '*.* '*** * *.. *.... *... * '*...* * MESSAGE AREA. * *** '*'** * *.. **** * .... *... MESSAGE AREA." * * *. *.... ...** ......... MESSAGE AREA*"'...." *.,~ *........... '*... ........'*.'*'*'*...~..............LINE 4 I:-' ru w ~ In IT" ~ []:> ~ []:> ~ IT" I.r1 ..c W ru I:-' Cl Cl I::-' W W I.r1 I.r1 I::-' ru Cl I::-' Cl Cl Cl Cl )>"U.-t....t.... ~ )> -< ~9ti~~ ~ ::J N 0 -1[IJ}>mz -< W ~ OOZOo S -1)>0 :iEx-<oo ... ~~cC ~8~mm ~ UlO:D ~ ? ~ ~. -i m 8 ~ " (Jl~ N !. -I~ ~ 0 0.... o' 0 0 ::;0 0 ::J ~ 0 0 ., 0 ~ ~. ~ -0 Nl? 0<1> ~ _ 0 ~'~g ~ 0lC'l C -..j,g- ~ 12,a . ~z !)> ~ gHjwg ~ .j::o '0' W, C = w;~ c.n:~ ~! "'0 'le '<1> I::-' ru w ..c In IT" ~ [)> ~ [)> ~ IT" I.r1 ..c W ru I::-' Cl Cl I:-' W W I.r1 I.r1 I:-' ru Cl I::-' Cl Cl > "'O.-t....L. ~ )> ~ ~9tj~~ ~ ::J N 0 -1tD)>mz :; -< W ~ oozoo S -1)>0 :iEX-<Oo /;;" o ::J ~ zocnmm " :iE-<cc , o-i Q .::J (Jl~ UlO:D ~ -i m .... -. m (Jl ;;; N 0 -i " 0 ~ -I <1> ~ 0 .... o' 0 S 0 0 0 ::J '" 0 ~ 0 iil 0 ~ 0: " " .. -0 --!o ~ ~ t\.), S' w' _;0 .j::o)>O~ ",.C'l 0 <1> ~g C CXlS S to..... i ~ CXl'Z :)> '< O:c ~13 al "', 3 w 0 _. .j::o'g ~:S = W,..., O1.ro+ ~: C11iO c A FORMUNIS" Your Organization 1 23 Any Street Any City, ST 00000 Address Service Requested 11111,111.1,111111,,111..11111.1.1,11.11.1.111.1,111 JOHN DOE JANE DOE 123 ANY STREET P.O. BOX 000 ANY TOWN, ST 00000 A FORMUNIS" Your Organization 123 Any Street Any City, ST 00000 Address Service Requested 11I"'11..111I1111....1'111111I1.1111.1111.1...1..11 JOHN DOE JANE DOE 123 ANY STREET P.O. BOX 000 ANY TOWN, ST 00000 PRESORTED FIRST-CLASS MAil U,S, POSTAGE PAID PORTLAND, ME PERMIT NO, 4 PRESORTED FIRST-CLASS MAil U,S, POSTAGE PAID PORTLAND, ME PERMIT NO, 4 A FORMUNIS.. Your Organization 123 Any Street Any City, ST 00000 Address Service Requested 111111.1..11111111"1.1..111...1.11.111..1.11..1..11 JOHN DOE JANE DOE 123 ANY STREET P.O. BOX 000 ANY TOWN, ST 00000 A FORMUNIS" Your Organization 123 Any Street Any City, ST 00000 Address Service Requested 111"'111.1"11111"111..111111111111.1111.11..1..11 JOHN DOE JANE DOE 123 ANY STREET P.O. BOX 000 ANY TOWN; ST 00000 PRESORTED FIRST,ClASS MAIL U,S, POSTAGE PAID PORTLAND, ME PERMIT NO, 4 PRESORTED FIRST-CLASS MAil U.S, POSTAGE PAID PORTLAND, ME PERMIT NO, 4 <:::-1: -' 'i I I . <J! /r"'l <.......J <~....'..'1 i .................i I . I I I <,'/j I '-",,! 1 " 1 1 I /,/"i I "'-",.j I I I I I I I 1 1 I I C:> i I I I I I I I I I 0000000000006042000800040600900000221440 I u -- -- --- -1----1 I WATER & SEWER BILL REMIT PORTION I I ; .1 v v I I , I Ii""" !.<",-",,, ["""" l/./' I f.......,......~ l' ,/ ..,.... I", ......~> 1/' ,- I', """'" ....//. ["'" L......./~> co C\I C') o C') o 0; o ci z w a. t-' tt <'.~J <::j 1 I I ! I -...., I ,.> J I I I '~ : 0000000000006042000800040600900000221440 <:1 / I I '~ .. R-_____num_nmh_mum_._______...__'____nn___'___....______..________m___h___.._..________n'___h_..____.________,_._u__..._____,___U.........m'..n_-----------..mnmn-------.m---.------..----m-.......-....-11 I I THIS IS YOUR RETURN ENVELOPE I ... 1. DETACH ALONG THIS PERFORATION. ... i : , Reorder VersaSeaI™ Style, RC8~413A , 2. MOISTEN AND FOLD FLAP TO SEAL. I +-t------ -----'-1 I r"'l I. j I I 1 I I I I I I I I I I I I I I I I I I I I I I -I I I 1 I, 1 I! I I L",,j , I I,] I: ._ __ __ __ __ __ __ __ __ - - __ - _ __" - - __ __ __ - - - - __ __ _. __ __ __ - _... - - - __ .. .. __ - - __ __ .. __ __ - - - __ . __ - - - 1. - _--\ 1'1 ._ v ,. , A FORMUNIS~ WATER & SEWER BILL Your Organization 123 Any Streat Any City, ST 00000 Customer Copy Keep this portion for your records Customer JOHN DOE Bill Date 11/23/00 Charge Service Address 789 ANY STREET Interest Bllgins 12/22/00 Previous tv!eter. .~eadi~g Bill Number <i 40600 ;> 0 Description III Q. 0) ::> '" REGS58 'c " REGW58 E (; u. 10 '0 12 SERVICE (; 1! 8 CODES '" 0 AVAILABLE ~ ;;; <t 0 0 0) .. u ~ccount/llum\:ler" E-3-140-004 Previous Read Date Present Read Date Present Meter.. Reading Usage 64 64 83,20 138.24 08/24/2000 OS/27/2000 2912 2848 . La~t Pay Amt " NO HISTORY Last Payment Qate NO HISTORY PrillcipClI Past D4e _ , .00 P(jstpue !ntefe~t ,00 ., Currllnt 9harglls ,.. . 221 .44 . . . - $221,44 COMMENT LINEn1 .......................................................................................................................................... COMMENT L1NE#2"'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' COMMENT L1NE#3......................................................................................................................................... COMMENT L1NE#4"'''''''''' ...... ... ... ...... .................. ... ... ... ... ... ... ... ... ... ... ... ... ... ............... ... ... ... ... ... ... ... ... ... ... ...... Account Number .- ,-.,- E-3-140-004 Past Due Amt ... .- -.- .--..-.- . P~._....- < .00 ., ,Cur.rEl.r'lt C~'l.rges .00 Amount Due -,,-_. ~._.- -" -_... $221.44 WATER & SEWER BILL I REMIT PORTION Account Number - .-.- E,3,140-004 Cu!!~n,~ Charges .00 Past Due Amt ,00 Amount Due . "'~". ....~~..._- .-.......-. _.~--~.^'---~- $221.44 JOHN DOE JANE DOE 789 ANY STREET PO BOX 999 ANY CITY, ST 00000 0000000000006042000800040600900000221440 \ LJ i r"l <.../......1 ''''"J tJ ~ c .Q <ti <5 't: Q) a.. g> I o I <( I ~ I (E I u ! c \ <II I ~ I Ii. \ I I C I Q) g~; ~ ! l.! l-i' I I ~ C .Q <ii (; 't: Q) a.. 0> C o <( {ij (E u C <II '0 '0 Ii. I C a.> a. o ~ ~! From: o Check here if change of address A FORMUNIS,. 111...1'1111111.1...11.1..1111'1111111'11.11.11.1..1 Your Organization P.O. Bo x 1 1 1 Any City I 5T 00000-0000 L a5p3 S!4.L JapUn Ja5u!.:l ap!lS - ap!s S!4.L uado O.L J Your Organization 123 Any Street Any City, ST 00000 Place First Class Stamp Here PRESORTED FIRST-CLASS MAIL U,S. POSTAGE PAID PORTLAND, ME PERMIT NO.4 11111.11...11...11...1111,".11'11.1"111111.111...11....1..II JOHN DOE JANE DOE 789 ANY STREET PO BOX 999 ANY CITY, 5T 00000 . r-'~......'=. L~"'''''';~. t -; .~ d o '0 (1) I :J I "T1 o a: tll :J a. ,0;1 ~ )> 6" :J <0 "C (1) ~ o . -.d iil --:l- o' , :J ~ U4 -1 ~ d o '0 (1) :J I "T1 o a: tll :J a. 0;1 ~ I)> 6" :J <0 "C (1) ~ o a o' , :J ~ I Customer John Doe [ ] [ Utility Bill J Current Charges Your Organization Public Service Authority Location 1 23 Any Street "Ill a. " 'IJ ! I II I U o a Code Current Meter Previous Meter Usage Charge ...~- . Reading -_.,--- .~- ","~" ...- Rea9iIl.Q..., . ,,,-- ." -_.... .. ..., .' . _.- ~...~-,._- - --.--.- Water 101250 85625 15625 34.77 Sewer 360000 310000 50000 50.00 Fire 360000 310000 50000 50.00 SR/Disc-3 [ .52] SR/Disc-72 [ 1,63] C) z 15 z w a. f- z W f- <( a. A FORMUNIS- Mail To: Your Organization PSA P.O. Box 000 Any City, St 00000-0000 I __.I2,ill _NuJ!1b.!lL "..,!;3ill Qate . . . . .,-. ~.. . I 1 23456 1 2/01/00 1211 5/00 .....,. .,_,_A~.~.9JJ!ltNl,Jmber -,_.,----, ,.,_"'..I..GJ,J$J9..m..e.L~.9-'-,. 444444444 999999 .,.. _..b<l.s,t.E.a.ymemA.r!1.(JUfl~., m _ ,.b<l.!>J"p'a.Y.m!lD.tRJ!~.'L. 200.00 1 1 /08/00 --.... ,.,..Am9l,J[l.t .easJ.QI.,I!L__._ __~,C:,U[LE!,m ..GbJiIJ9!'1s .c,.. 50.00 1 34.77 . . . . 1 84.77 *******************This is a 4 line comment field****************~*** ************************************************************* ************************************************************* ************************************************************* --------------------------------T--------------------------------- I I I I I I I I - -- - _ - ~- .~ - .- _ _ _ _ --_, ,__ .- _ - _ - - - - - - -1- - ~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- I I ... I U1 I .po. I O'l I U1 I .po. I c:; N ... U1 .po. O'l U1 co .po. ... : II LIFT TAB ANO SLOWLY PULL Tn YOUR RIGHT; DETACH AND RETURN LOWER PORTION WITH REMITTANCE IN RETURN ENVELOPE w U1 .po. I~ I .po. I ... I I I I I I I I I I I -i- -.----------- I I .See Reverse Side For Opening Instructions. Your Organization PSA : P.O. Box 000 I Any City, ST 00000-0000 0000-00000 1S 'Al!:) Au'V 000 x08 'O'd 'VSd UO!leZ!ue6JO JnoA 11"11111' 1"1111111111I11' 11111' 11111I11I1111111111 1717171717'17171717 9J9H dWBlS , 9:>Bld :II\IOtl:l FORMUNIS,. Address Service Requested W N ... :...,~.~.Ri~:la'a1irn:lt'~l.II.lIl.' ~I W N ... W U1 O'l .po. O'l 199.77 Call 800.451,1709 to reorder Formunis USPS 14SE V.4. 1 )>)>'Uc....c.... :J:Jo"'o '<'<. ~ 5 -1UlOJOO ~~ooo <CDXCDCD ..~ ~ <0 (0 C (0 Ul )> )> :-0 -< :J 0 0 '<. c: Q g' ... -::: x 0 "T\ (J) 0 ... 0 -l g ~ :l:J g :;, 3:: g i::r c o III 6 ... Z o 0'- g :;, UI "tJ' (f) )> ... ::r iii' " o ~ o' :;, ;;Q CD ... c: ... :;, 01 01 01 01 'f ~ ~ ~ ~ 00- ~Io I ~lffi 01'0 . -I", )> Ojr+ In 0, CD tig . -L , ./=>; c: ./=>' :J ./=>,.... . ~I~ ./=>'z ./=> c: co,o ./=>'3 ./=>1 c: ./=>cr . ':J ;~ . -...II.... -...Ii 0 Iffi I ! ~ ;:;: ::r ~I c: ... ... CD I 3 ;:j: ... III :;, o CD [ [ ] J PRESORTED FIRST-CLASS MAIL U.S, POSTAGE PAID 1 OUNCE YOUR 5T A TE PERMIT NO.1 11I1111111111111111111111111111111111111111111111I11 John Doe Jane Doe P.O. Box 999 I Any Street I Any Town, USA 55555-1111 L_________________________________ .- -j I I i U) ,I I f~ ~ I' . TO OPEN -SLIDE FINGER UNDER FLAP AND PEEL BACK .. \- J J A Ynur Organization Utility Bill :x> we.... "1'1 ::c 0 :J 00 0 CD Water & Sewer Division -' -< 0 I ... 1 23 Any Street 0 D$:Z :c c: ... Customer Copy -' ....:x>0 3: :;'n Any City, ST 00000 0 :< - 0 FORMUNISN 800.451,1709 -' enzm c: ... 0 -len ::r I -' o-l Z iij'LJ A<':COlJfltNurnbe[ Amol!nt DUE! 0 0:0 "C -- , -' o~ III 0 1003-00 484.06 O-l ... 0 ... N :x> ~ -< o' a N N ~~o :;, 0 N ('):X> c:: ~ 11 Name: JOHN DOE ;::+':J .... -. ~ .jl> :<-<0 .... 00 en ~ ... ::r~ 0 < - Location: 300 MAIN STREET -l ro co o A '-oJ o CTl Q) c: ....... c.o 0.... :J ...'11 From: 06/06/99 To: 12/01/99 c.o III 0' _. ... .. 0'1 0:2: N CD .jl> OOol Q) 3 Meter ReadinQ 0) ........ Code Date Read Meter Number Usage Charge CTl _. ;:+ Present PrevIous '-oJ ~ 0 or 1--/ N 9.:J W64 12/15/1999 32 101250 85625 15625 34,77 0) < :;, - 0'1 (ii' n ~ W64 12/15/1999 33 360000 310000 50000 50,00 00 15' CD L_J W64 12/15/1999 34 360000 310000 50000 50,00 0'1 :J c.o 0) .jl> -' .... N 0 NO '-oJ -c W ~CTl N -0 .. ~,~ (DC!> (DI I L_J I I I I I I --~------------------------------------------~--------------------- Ii Past Due 349.29 This Billing 134.77 484.06 IF YOU CHOOSE TO PAY YOUR BILL IN PERSON, THE OFFICE HOURS HAVE CHANGED TO 8:30AM TO 4:30PM, MONDAY I THROUGH FRIDAY, PLEASE MAKE CHECKS PAYABLE TO YOUR ORGANIZATION, WATER & SEWER DIVISION, n LJ .---CD DETACH THIS PORTION ALONG PERFORATION---. I [ 1--1 LJ @) n l._J n I I ~ TO OPEN -SLIDE FINGER UNDER THIS FLAP AND PEEL BACK .. 0 ." 0 0 Z r Ll -4 0 ." -t 0 I :II en G> m ." -t s;: -t "ll 0 0 Z < -<en m :II 093 )> n e-t Z :II-< 0 00 :E Ie m:II m LJ O:II -t ?"m =i -t -t e 0 :II Z en en m )> -t r e III m )> z < z m 0 r n en 0 G5 "0 Z m , LJ ~ Account Number ...~ ..---. -.- -- ~'~----'-- E-3-140-004 _!~.!.~~~~!_ ~~giQ~_, 12/22/99 WATER & SEWER BILL Remit Copy Please write your account number on your check and enclose this portion of bill with your payment. Make checks payable to: Your Organization .".. Pa~_,g..ll.~ lnte~est ,f".~~!pal P~s~.-9~~~.!:!.':!en~~h!r_!:I,~_ ,00 .00 221.44 A FORMUNISN Your Organization 123 Any Street Any City, ST 00000 . ,. $221.44 E-3-140,004 JOHN DOE JANE DOE 789 ANY STREET PO BOX 999 ANY CITY, ST 00000 111.11111.1..11111111.1.1..11..111I11111.1.111.1.1.1 Please Note Address Correction Below: Name Street City State Zip 0000000000006042000800040600900000221440 A FORMUNISN Your Organization 123 Any Street Any City, ST 00000 WATER & SEWER BILL Customer Copy Keep this portion for your records -i ::> w <t iii u lD :;) '" 'i: :J E (; u. Customer .,. ---'--1----.----- ,.- Service Address - -.,.-- --- -<.- ._...._~..._----,-_.... .......-.----.- -_.--- . -..,.,. ~~.- n_.,. --.. -~ .--.--- ..~_..~......"-~.~....__. '-"'-'-"""-"-'~'"'" ". ._."-_._----_..._..._._-,-~.._-_._..~....__.~.._--~-.-,~ JOHN DOE 789 ANY STREET ---.--~ilk~~~ge.L--..--I--------_.--- ,. '-f\c~~~i~~-66~e.L~_---,',...--_m 1-,-- -,,,,-JQtijjij~~~!"-!l-"-----"I----m_m-..-.--~~~~/~~~------- -, - Qe.S9rijJtjpD_ , .... , f'@sel}t5El.<l.~U:>a!El . ..J:>[e..Y.i..<?'::ILRElllQ,..Q"ll!!t_ J:>[Ell!ent_ M.!l..tElrJle.,!Qi!lg_ -':>revioullJ~eter Re_aQing,. ,.'::.~Bt~g'J.J~~t'.:'..... _____GJ:1'!!g,El~_ REGS58 64 83,20 REGW58 08/24/1999 OS/27/1999 2912 2848 64 138,24 Last PaymElnt Amt LastPaymEll11DllJe. ,. ,.".Prir"::iPClI Pa!lt [)ue. ' Past Due Interest . ,~~!re.n.t 9harges .. . . . ,. . ~. . .''''-'' .00 NO HISTORY ,00 .00 221 .44 $221.44 . l;; '0 (; ~ 9 0> o ,... '" <t o o co a; U COMMENT LINEN1 ................................................................................................................ COMMENT LINE#2'" .............. .. .. ...... .. .. ... ........ .. .. .. .. .... .. ... ... ...... ..... .. ... ... .. .. .. ............................. COMMENT LINE#3"''''''''''''''''''' .. ................ ... ... ............... ..... .. ... ..... ........ .. .. .. .. ..... .............. ............... COMMENT LINE#4" ............... .. .. .. ... ... ........ .. .. ..... ...... ......... ... ... .... ....... .. .. ..................................... If you aremailingpaymentonly.mail to: Your Organization P.O. Box 111 Any City, ST 00000 BILL IS DUE UPON PRESENTATION For all correspondence or payment in person: Your Organization 123 Any Street Any City, ST 00000 Subject to interest & suspension of service if not paid within 30 days of billing date, Interest: 8% per annum on total of arrears up to $1,500,00 18% per annum on total amount of arrears greater than $1,500.00 Bad Check Charge: $20.00 per account Office Hours: 8:30AM to 4:30PM Monday through Friday Phones: 1 (222) 222-2222 Daytime Phone 1 (888) 888-8888 Off Hour Emergencies KEEP LEAD FREE.............FLUSH TAP DAILY! 100 CU. FT. = 748 Gallons Rate per 100 cubic feet. Consumption billed in hundreds of cubic feet. Non-receipt of issued bill not deemed excuse for failure to pay, Property owner responsible for protection of meter from loss and from hot water, freezing or other damage. Any person other than an employee of this Water Company who turns water off or on at curb cock, without permission, is liable to a fine. From: Place First Class Stamp Here o Check here if change of address 111...1...111...1...11.1..11....1..111....1..11.1..1 Your Organization P.O. Box 111 Any City I 5T 00000-0000 E-3-140-004 JOHN DOE JANE DOE 789 ANY STREET PO BOX 999 ANY CITY, ST 00000 1'1111..1.1..11..1111.1.11111..1...11111.1.1...1.1.1 A FORMUNIS~ A FORMUNIS~ <i :> (f) u I- ID ::> '" 'E ::> E (; u. Bill Number 40600 Description WATER NMTR SEWER NMTR SWRNMT CAP WTRNMT CAP Q; '0 (; e 9 m o r-- It) '" o g Last PaymentA~t ,00 ro u Your Organization 123 Any Street Any City, ST 00000 WATER & SEWER BILL Remit Copy Please write your account number on your check and enclose this portion of bill with your payment. Make checks payable to: Your Organization Account Number E-3-140-004 . . ,_Interest Begins :, 12/22/00 Pas! Due,.Interest ,00 Principal Past DLJe. .00 Currer'lt Char!)es 250,19 $250.19 Please Note Address Correction Below: Name Street City Zip State 0000000000006042000800040600900000221440 Your Organization 1 23 Any Street Any City, ST 00000 WATER & SEWER BILL Customer Copy Keep this portion for your records Customer JOHN DOE Bill Date 11/23/00 Usage 64 Service Address 789 ANY STREET Interest Begins 12/22/00 Present Mete.r Reading ,Previous Meter ReadinR . Present Read Date 08/24/2000 Account Number E-3-140-004 Previous Read Date 05/27/2000 2912 2848 e ~e\09 * et' (\'\ .. n((\e U \l'" Charge 83,20 138.24 12.75 16.00 \' a ,\09 e ~\ eS Ss\(\<) ,) : te~ oce -\ ~t(t\ (t\3\\ 9 . Current Charges 250,19 Past Due Interest .00 al Past Due .00 . . $250.19 COMMENT L1NE#1 * * * * *...................................................................................... COMMENT L1NE#2""""""""'''''''''''''''''''''''''''''''''''''''''''''''''''' ... ... ... .... .... ..... .. .. .. .... COMMENT L1NE#3"""""""""''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' COMMENT L1NE#4"'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' If you aremailingpaymentonly.mail to: Your Organization P,O, Box 111 Any City, ST 00000 BILL IS DUE UPON PRESENTATION For all correspondence or payment in person: Your Organization 123 Any Street Any City, ST 00000 Subject to interest & suspension of service if not paid within 30 days of billing date, Interest: 8% per annum on total of arrears up to $1,500,00 18% per annum on total amount of arrears greater than $1,500,00 Bad Check Charge: $20,00 per account Office Hours: 8:30AM to 4:30PM Monday through Friday Phones: 1 (222) 222-2222 Daytime Phone 1 (888) 888-8888 Off Hour Emergencies KEEP LEAD FREE.............FLUSH TAP DAILY! 100 CU. FT. = 748 Gallons Rate per 100 cubic feet. Consumption billed in hundreds of cubic feet, Non-receipt of issued bill not deemed excuse for failure to pay. Property owner responsible for protection of meter from loss and from hot water, freezing or other damage. Any person other than an employee of this Water Company who turns water off or on at curb cock, without permission, is liable to a fine, A FORMUNIS~ Your Organization 1 23 Any Street Any City, ST 00000 Customer JOHN DOE <i ::> en U co co => "' 'c :> E o u.. Bill Number 40600 De~cription WATER NMTR SEWER NMTR SWRNMT CAP WTRNMT CAP Present Reap DCi!e 08/24/2000 Account ,Number E-3-140-004 , ,Pre"i()us Fl~a~ Date OS/27/2000 Q; '0 o ~ 8 en o ,... ~\te ~ te~ -, 9 t\'. ~3\\ g "' .. c:i g Last Paym~nt Arrlt ,00 ;;; u WATER & SEWER BILL Customer Copy Keep this portion for your records 'Service Address 789 ANY STREET Interest B.egins 12/22/00 Present ~~terReading ,p'revious MeteLRead,in 2912 Bill Date 11/23/00 ,Usage 64 284~\09 e(\~ * ~ 39 e(\'\. ;\'\.o~ ~\9t\' 3 \)0 _~g e eSS~ OC Past Due Interest ,00 COMMENT LINEII1 ......................................................................................................................................... COMMENT L1NE#2"''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' ... ... ... ... ... COMMENT lINE#3"'''''''''' .............................. ... ... ...... ... ... ......... ... ...... ...... ...... ... ... ... ...... ............... ... ......... ... ... COMMENT L1NE#4"''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' BILL IS DUE UPON PRESENTATION Subject to interest & suspension of service if not paid within 30 days of billing date, Interest: 8% per annum on total of arrears up to $1,500,00 18% per annum on total amount of arrears greater than $1,500,00 Bad Check Charge: $20,00 per account KEEP LEAD FREE.............FLUSH TAPDAILY! 100 CU. FT. = 748 Gallons Rate per 100 cubic feet. A FORMUNIS~ Your Organization 123 Any Street Any City, ST 00000 Account Number E-3-140-004 E-3-140-004 JOHN DOE JANE DOE 789 ANY STREET PO BOX 999 ANY CITY, ST 00000 1...11..1.1..11..1..1.1.1..11..1...11..1.1.1...1.1.1 Interes_t...Begin~ 12/22/00 C.harge 83.20 138.24 12.75 16,00 Current Charges 250.19 . . $250.19 If you aremailingpaymentonly.mail to: Your Organization P.O, Box 111 Any City, ST 00000 For all correspondence or payment in person: Your Organization 123 Any Street Any City, ST 00000 Office Hours: 8:30AM to 4:30PM Monday through Friday Phones: 1 (222) 222-2222 Daytime Phone 1 (888) 888-8888 Off Hour Emergencies Consumption billed in hundreds of cubic feet, Non,receipt of issued bill not deemed excuse for failure to pay, Property owner responsible for protection of meter from loss and from hot water, freezing or other damage, Any person other than an employee of this Water Company who turns water off or on at curb cock, without permission, is liable to a fine, WATER & SEWER BILL Remit Copy Please write your account number on your check and enclose this portion of bill with your payment, Make checks payable to: Your Organization Past Due Interest .00 Principal Pa~t Due ,00 Current Charges 250.19 . . $250.19 Please Note Address Correction Below: Name Street City State Zip 0000000000006042000800040600900000221440 THE COMMONWEALTH OF MASSACHUSETTS CITY OF BROCKTON - OFFICE OF THE COLLECTOR OF TAXES ALL PAYMENTS MUST BE MADE TO THE CITY OF BROCKTON BILLS PAYABLE AT TAX COLLECTOR'S OFFICE WEEKDAYS 8;30 A.M, TO 4:30 P,M, 45 SCHOOL STREET, BROCKTON. MA 02301-4059 DPW WATER, SEWER, REFUSE UTILITY BILL ACCOUNT NO. BILL NUMBER .;, ":, PARCEL 10 'ISSUE DATE ',,.: . ,- ~, .."AMOUNT DUE;-~',.:.: .:. ' . ' LOCATION: SEE REVERSE SIDE FOR IMPORTANT INFORMATION INTEREST AT THE RATE OF 14% PER ANNUM WILL ACCRUE ON OVERDUE PAYMENTS FROM THE FIRST DAY THE PAYMENT IS OVERDUE UNTIL PAYMENT IS MADE. TREASURER/COLLECTOR JAMES F. MARTELLI, JR. CODE PREVIOUS CURRENT PREVIOUS, CURRENT, USAGE : CHARGE READ DATE READ DATE READING READING - DUE DATE I INTEREST DUE I PAST DUE I CURRENT CHARGES I AMOUNT DUE I I I I INOUIRIES: Your Account No. and Bill Number will be required for inquiries. Questions regarding Water/Sewer/Refuse billing information should be directed to the DPW at (508)580-7143, Questions regarding payments should be directed to the Collector's Office at (508) 580-7130, YOUR CANCELLED CHECK IS YOUR RECEIPT. PLE~SE USE ENCLOSED ENVELOPE FOR PAYMENT ' THE COMMONWEALTH OF MASSACHUSETTS CITY OF BROCKTON - OFFICE OF THE COLLECTOR OF TAXES ALL PAYMENTS MUST BE MADE TO THE CITY OF BROCKTON BILLS PAYABLE AT TAX COLLECTOR'S OFFICE WEEKDAYS 8;30 A.M, TO 4:30 P.M. 45 SCHOOL STREET, BROCKTON, MA 02301-4059 DPW WATER, SEWER, REFUSE UTILITY BILL MAKE CHECKS PAYABLE TO: CITY OF BROCKTON TREASURER/COLLECTOR JAMES F. MARTELLI, JR. ISSUE DATE, PARCEL 10 . ' BILL NUMBER:' ,) INTEREST DUE :0 ~ '0 c: '0 ..~ '0 '0.": : CI'I ~ ~E . ~ ~ ~ g ~ > ,,~ 0.'"::- 0:: ~ LOCATION: PAST DUE CURRENT CHARGE AMOUNT DUE NOW Please write your Account No. on your check - ~ o Have your Account No. and Bill Number for any inquiries. If VOl! have OUFSTIONS '. I AboUl ICdl Telenhone . I USAGE or CHARGE Rdu,;e I OPW Billin", Refw.:e (5US) 580-71:15 USAGE or CHARGE Sell'er I DrW Billin~ - Sell'er (50S1 580-7 J 37 USAGE or CH;\RGE W~ter I DPW Bill in" - Water I (50S) 580-7143 P~\\'menl/1NTEREST OR PAST DUE I Tax Collector's Office I (50S) 580-/1:10 Watcr or Se\\'er ~cl'\'ice I Ulililic~ !)i\'i,ioii I (50S) 5S0-7S65 !\'leter Reauil1!:~ I ~ktn Divi,ion I (50S) 5S0,/1;65 I Refuse: I Waste Mana~e:mcnt I (508) 5S0-(J9..1~ Water connections I \Valcr Cornmi::>ion (50S) 941-0264 I I Gcnerallnformation I Df'W Comrnis,iolh~r I (50S) 580-71 :;) WATER & SEWEROUARTERLY BLOCK RATES ! USAGE in Cunic Feet I Water rate ncr 100 cubic fOOL I SCII'er r:l\e ncr 100 cunic foot I o to ).500 S I.SO I S 1.79 ).501 to 5.000 $J.35 152,24 5.001 1010,000 $).45 I S',63 10,001 to 25.000 S2,55 I 53.!l1 25.001 10875.000 S2,(iO I S3.28 Grcaler than 875.00 I S2,(iO I S3,80 I REFUSE OUARTERL Y BILLING Number of units Charge ] S27.50 2 555.00 3 582.50 4 5 J !O.OO , 5 $137,50 MINUvlUM \V ATER USAGE BILLED PER METER SIZE I iV!cler Size Wat"r Allowance (Cu Ft) 4" I JiU50 (i" I 37,500 8" 86,250 10" 1~2.50() 12" 217.500 l\'l0ler Size Water Allowancc (ClI Fl) 5/8" and ii," 750 J" I 1,875 1 '/," and I '/," 3.750 ")" 6,()[)() 3" 12,O()() CONSERVE WATER!! 1111,11111.11,1111...11,,111,,111...11,1.111..11...1 JOHN DOE JANE DOE P.O. BOX 999 123 ANY STREET ANY CITY ST 00000 11111.1111.1111111,1.111111111.111111111.11111111111 JOHN DOE JANE DOE P.O. BOX 999 123 ANY STREET ANY CITY ST 00000 The Commonwealth of Massachusetts Make Payments To: DO NOT MAIL CASH Your Organization P.O. Box 000 Any City, ST 00000-0000 Tax Date 03 / 31 ...,le.rlth an.d. Na.':Tle, o! ~~at._,_Reg,Qr,Dq~, N.umb~r. 18 VICTORY 819764 Notice For receipt, enclose a stamped envelope with bill, If no receipt is desired, forward bill with remittance. , IF EXCISE REMAINS UNPAID, YOU Will BE SUBJECT TO PENALTY OF $20.00 OR 20%, i,!, WHICHEVER IS GREATER, PLUS INTEREST AND COSTS, IF ANY. 1 ~~~a7ea:fb:o:~titled to a refund or abatement, 1",,1 2. Removal of the owner to another state and registration of a boat in said other state and ! termination of registration in Massachusetts, i IF YOU ARE IN DOUBT AS TO YOUR RIGHTS, ,;'",,1, CONSULT YOUR ASSESSORS. The Commonwealth of Massachusetts Make Payments To: DO NOT MAIL CASH Your Organization P.O. Box 000 Any City, ST 00000-0000 Tax Date lenth and Name of Boat 18 Reg. or 00.1::.. ~!Jm!;>er. 03 / 31 Notice of Boats, Ships and Vessels Excise Bill rn Q a: o u w a: a: :J o > a: o u.. > Q.. o U rn :I: .... Q.. W W ::.::: ___'J?i!!J'!g~ __" 56923 Due and payable in full within 60 days of issue Ir.lla~urer.LTa~ ,Cgl!!'l~tor JIM SMITH State Excise Rate .. ..., .........-. ----~~, -~ .- $10.00 $100nOO Excise Due ~_. _~. n_,_ ~_ ._~ ____ For further information regarding this notice, inquire of the board of assessors. Unless said excise is paid with 60 days of issue, you will subject to a penalty of $20,00 or 20% whichever is greater, plus demand of $5,00, interest and costs, if any, This form approved by the Commissioner of Revenue. , ." pat~_Q! !~,l>ue 03 / 31 / 2000 $220.00 Interest Demand '-~'~'--"'~-'-"----- . . ... . $220.00 6146545145416846213298978521974840596532 Application for Abatement Abatement No. Bill No. I hereby make application for an abatement of a fiscal year boat, ship and vessel excise. Date of sale or transfer Purchaser Removal to another state with proof of registration or surrender of Massachusetts registration or non-renewal of registration. Date of out of state reg. Date of termination of Massachusetts reg. Amount of tax $ Abatement *Balance due *Plus interest and costs, if any. Date Signature Call 800.451,1709 to reorder. Formunis B V,4, 1 Notice of Boats, Ships and Vessels Excise Bill .... Z w 2 > <( Q.. a: :J o > :I: .... ~ > Q.. o U ~ :I: .... Z a: :J .... w a: _,~ill No, 56923 Due and payable in full within 60 days of issue TreasurerlTax Collector .___ _.. ..' .' ~ '.' _ ._.. no _ _~__.>om_. . _ _ .~. State Excise Rate - $1 O:'(iO'-;~oon~;- Excise Due For further information regarding this notice, inquire of the board of assessors. Unless said excise is paid with 60 days of issue, you will subject to a penalty of $20.00 or 20% whichever is greater, plus demand of $5.00. interest and costs, if any, This form approved by the Commissioner of Revenue. $220.00 Interest m..__.. . .'._.._.._~....... JIM SMITH Date, of Issue 03 / 31 / 2000 Demand . . I .. $220.00 6146545145416846213298978521974840596532 Make Payments To: DO NOT MAIL CASH Your Organization P.O. Box 000 Any City, ST 00000-0000 Bill No. ---.. .~ ----- ...-.-" -.,... 56923 Notice of Motor Vehicle and Trailer Excise Bill The Commonwealth of Massachusetts $220.00 en Cl a: o () w a: a: => o > a: o u. > 0.. o () ~ J: ~ 0.. W W ~ Due and payable in full within 30 days of issue .fleg=J\JlJmb~r ". 819764 ,.Pat~_2fL~l!.~. ..... 03 / 31 / 2000 For further information regarding this notice, inquire of the board of assessors. If not paid when due, subject to penalties of interest, demand charges, and fees, This form approved by the Commissioner of Revenue. ?~CltEL~xc!S13...B'!.~~, $25.00 $1COnOO _~~i..s..~p...\!e., .. $220.00 ..ll}tE!.re~ ve~icleld. Nurl1ber.... _..:J:.!:E!.~,:?ure!rrax Co..llElctgr JIM SMITH .... T ~?<J?~El.. 03 / 31 11111.11...11...11...11...11...11"111...11'1.11...1 JOHN DOE JANE DOE P,O. BOX 999 123 ANY STREET ANY CITY ST 00000 ,._.g~r!1.'!.f.l..9_.._..".. . . . . 6146545145416846213298978521974840596532 NOTICE For a receipt, enclose a stamped envelope with entire bill, if no receipt is desired, DETACH COLLECTOR'S COPY and forward with remittance, IF NOT PAID. YOUR REGISTRATION AND YOUR DRIVER'S LICENSE MAY NOT BE RENEWED. You may be entitled to refund or abatement. {al when the motor vehicle is sold or traded and the registration is cancelled or transferred to another vehicle, (b) when a registrant and a motor vehicle are tranferred to another state or country with proof of registration in such other state or country and proof of cancellation of registration in Massachusetts. (c) when vehicle is overvalued. (d) when there is subsequent registration of the same motor vehicle in the same year by the same person. (e) when the registrant has notified the local police authorities within 48 hours of the theft of the motor vehicle and has surrendered the certificate of registration to the Registrar not sooner than 30 days subsequent to the date of the theft and obtained a certificate setting forth the facts. Application for abatement or refund must be filed with the Board of Assessors in writing on an approved form on or before December 31 st of the year following the year for which the excise is assessed, or if the notice of excise is first sent after December 1 st of such succeeding year, on or before the 30th day after the notice of excise is sent. Forms to apply for abatement will be mailed on request from the Assessor's office, No excise may be reduced to less than $5,00, No abatement of less than $5.00 will be granted and no refund of less than $5,00 will be made. IF YOU ARE IN DOUBT AS TO YOUR RIGHTS CONSULT YOUR ASSESSORS. Call 800,451,1709 to reorder, Formunis MV VA,1 The Commonwealth of Massachusetts Year "..I3iU.No, 56923 Notice of Motor Vehicle and Trailer Excise Bill fleg. Number.. 819764 $220.00 ~ 2: w ~ > <( 0.. a: => o > J: ~ ~ > 0.. o () ~ J: ~ 2: a: => ~ w a: 2000 Make Payments To: DO NOT MAIL CASH Your Organization P.O. Box 000 Any City, ST 00000,0000 Due and payable in full within 30 days of issue Vehicle Id. Number .. .--.-..... ." ,. .-r.r.easurElrl~!<, Co"ec~()r...... JIM SMITH Date of Issue 03 / 31 / 2000 For further information regarding this notice, inquire of the board of assessors, If not paid when due, subject to penalties of interest, demand charges, and fees. This form approved by the Commissioner of Revenue. State Excise Rate ....$25...00 .. ~~~n~~" Excise Due T ax Date 03/31 Interest 11111I11,111111111,111111.1111111,111111111111111111 JOHN DOE JAN E DOE P,O. BOX 999 123 ANY STREET ANY CITY ST 00000 Demand -..-..--.-..... -~_._._--_..'._.~- ..~-' . . . . $220.00 6146545145416846213298978521974840596532 YOUR ORGANIZATION FIRST QUARTER PERSONAL PROPERTY PRELIMINARY TAX BILL Taxpayer Copy THE COMMONWEALTH OF MASSACHUSETTS Make check payable and mail to: Your Organization P.O. Box 000 Any City. ST 00000-0000 THIS FORM APPROVED BY THE DEPARTMENT OF REVENUE, 2000 Treasurer/Tax Collector: Jim Smith Office Hours: Monday - Friday 8:30AM - 4:30PM lOCATION 128 SYCAMORE LANE PARCEL 19-255-0014 FISCAL YEAR BEGINNING JULY 1, 1999 AND ENDING JUNE 30, 2000 111...11...11...11...11......11...11...11...11.11..1 JOHN DOE JANE DOE P.O. BOX 999 123 ANY STREET ANY CITY ST 00000-0000 TOTAL PERSONAL PROPERTY PRELIMINARY TAX $1,800,00 $900.00 $1,800.00 I 1 ST QUARTER INSTALLMENT I TOTAL DUE BY AUGUST 2. 1999 INTEREST AT THE RATE OF 14% PER ANNUM WILL ACCRUE ON OVERDUE PAYMENTS UNTIL PAYMENT IS MADE, 1234567890123456789012345678901234567890 YOUR ORGANIZATION FIRST QUARTER PERSONAL PROPERTY PRELIMINARY TAX BILL THE COMMONWEALTH OF MASSACHUSETTS Return With Payment Make check payable and mail to: Your Organization P.O. Box 000 Any City, ST 00000-0000 THIS FORM APPROVED BY THE DEPARTMENT OF REVENUE, 07/01/99 2000 PROPERTY DESCRIPTION AND LOCATION TreasurerlTax Collector: Jim Smith Office Hours: Monday. Friday 8:30AM - 4:30PM LOCATION 128 SYCAMORE LANE PARCEL 19-255-0014 FISCAL YEAR BEGINNING JULY 1, 1999 AND ENDING JUNE 30, 2000 111...11...11...11...11......11...11...11...11.11..1 JOHN DOE JANE DOE P.O. BOX 999 123 ANY STREET ANY CITY ST 00000-0000 TOTAL PERSONAL PROPERTY PRELIMINARY TAX $1,800.00 $900.00 $1,800.001 1ST QUARTER INSTALLMENT I TOTAL DUE BY AUGUST 2. 1999 INTEREST AT THE RATE OF 14% PER ANNUM WILL ACCRUE ON OVERDUE PAYMENTS UNTIL PAYMENT IS MADE. 1234567890123456789012345678901234567890 YOUR ORGANIZATION SCHOLARSHIP FUND OPTIONAL INFORMATION MAIL TO: Your Organization Scholarship Committee Your Organization Town Hall 100 Any Street Any City, ST 00000 .. :> (f) u 11. 11. a: I- a Donor Name: Address: .. 'E ::> E (; LL Check off the amount you wish to contribute and write the amount in the space provided. Your contribution is in addition to the property tax shown above. Make a separate check payable to: Your Organization Scholarship Fund li; '0 (; i!! B Ol o ,.. $1.00 D $2.00 D $5.00 D $10.00 D Other '" <t Voluntary Contribution ~ Amount is: B Amount of Contribution: D 1$ I '1._ J L, J YOUR ORGANIZATION FOURTH QUARTER REAL ESTATE TAX BILL Type MISC ADDL $349.61 $166.98 Return With Payment THIS FORM APPROVED BY THE DEPARTMENT Of REVENUE, THE COMMONWEALTH OF MASSACHUSETTS Make check payable and mail to: Your Organization P.O. Box 000 Any City. ST 00000 Treasurer/Tax Collector: John Smith Office Hours: Mon - Fri SAM - 4PM Class Residential Open Space $Tax/$1000 14,49 14.49 Commercial Industrial 23,36 23.36 Interest at the rate of 14% per annum will accrue on overdue payments until payment Land/Buildino Total Valuation Class Land 123.45 AC 1,234 1789 Bldg 2000000 S.F, 56,789 Total Taxable Valuation: 58 023 Special Assessments I Amount Comm, Interest 11I11.11...1111.1111.1111'11.11...1111.1111.11.11..1 JOHN DOE JANE DOE P.O. BOX 999 123 ANY STREET ANY CITY 5T 00000-0000 Total Spec, Assess, $516.59 Total Real Estate Tax: Preliminary Tax Billed: Less: Payments Exemptions Special Assessment: Net Actual Tax: Preliminary Overdue: Actual Tax 3rd au: Actual Tax 4th atr: Interest to May 1, 2000: $1,921.23 $1,477,20 $967.62 $0,00 $0.00 $0,00 $0.00 $996.90 $480,30 $0,00 $1,477.20 I I Total Due Now By May 1, 2000: 1234567890123456789012345678901234567890 YOUR ORGANIZATION FOURTH QUARTER REAL ESTATE TAX BILL Taxpayer Copy THE COMMONWEALTH OF MASSACHUSETTS Make check payable and mail to: Your Organization P.O, Box 000 Any City, ST 00000 Treasurer/Tax Collector: John Smith Office Hours: Mon - Wed SAM - 4PM Ciass Residential Open Space Commercial Industrial $Tax/$ 1 000 14.49 14.49 23.36 23,36 Interest at the rate of 14% per annum will accrue on overdue payments until payment is made. Land/Buildino Total Valuation Class Land 123.45 AC 1,234 1789 Bldg 2000000 S,F, 56,789 Total Taxable Valuation: 58,023 Special Assessments Amount Comm, Interest Type MISC ADDL $349,61 $166,98 Total Spec, Assess, $516,59 Total Real Estate Tax: Preliminary Tax Billed: Less: Payments Exemptions Special Assessment: Net Actual Tax: Preliminary Overdue: Actual Tax 3rd atr: Actual Tax 4th atr: Interest to May 1, 2000: I Total Due Now By May 1, 2000: $1,921.23 $1,477.20 $967,62 $0.00 $0,00 $0,00 $0.00 $996.90 $480,30 $0.00 $1,477.20 111...11...11...11...11......11...11...11...11.11..1 JOHN DOE JANE DOE P.O, BOX 999 123 ANY STREET ANY CITY ST 00000-0000 FISCAL YEAR 2000 TAX: This tax bill shows the amount of real estate taxes you owe for fiscal year 2000 (July 1, 1999 - June 30, 2000). The tax shown in this bill is based on assessments as of January 1, 1999. The bill also shows betterments, special assessments and other charges. PAYMENT DUE DATES/INTEREST CHARGES: Your preliminary tax was payable in two installments if preliminary bills were mailed on or before August 2,( 1999, The first payment was due on August 2, 1999, or 30 da'r's after the bills weremailed.whicheverislater.andthesecondpaymentwasdueonNovemberl.1tl99. However, if preliminary tax bills were mailed after August 2, 1999, your preliminary tax was payable in full on November 1, 1999, or 30 days after the bills, whichever was later. Your preliminary tax is shown on this bill as a credit against your tax, including betterments, special assessments and other charges, If tax bills were mailed on or before December 31, 1999, the balance remaining is payable In two equal installments, Your first payment is due on February 1 2000. Your second payment is due on May 1, 2000. However, if tax bills were mailed after December 31, 1999, the entire balance remaining is due on May 1, 2000, or 30 days after the bills were mailed, whichever is later. If your payments are not made by their due dates, interest at the rate of 14% will be charged on the amount of the payment that is unpaid and overdue. If tax bills were mailed on or before December 31, 1999, interest will be computed on overdue first payments from February 1, 2000 and on overdue second payments from May 1, 2000 to the date payment is made, If tax bills were mailed after December 31, 1999, interest will be computed on overdue remaining payments from May 1, 2000, or the payment due date, whichever is later, to the date payment is made. You will also be required to pay charges and fees incurred for collection if your tax payments are not made when due, Payments are considered made when received by the collector, To obtain a receipted bill, enclose a self-addressed stamped envelope and both copies of the bill with your payment, ABATEMENT/EXEMPTION APPLICATIONS: You have a right to contest your assessment. To do so, you must file an application for an abatement in writing on an approved form with the Board of Assessors, You may apply for an allatement if you believe your property is valued at more than Its fair cash value, is not assessed fairly in comparison with other properties, or if a classified tax system is used locally, is not properly classified, If tax bills were mailed on or before December 31d 1999, the filing deadline for an abatement application is February 1,2000, However if tax bills were mailed after December 31, 1999, the deadline is May 1,2000, or 30 ays after the date the bills were mailed, whichever is later, You may be eligible for an exemption from or deferral of all or some or your tax, In order to obtain an exemption for which you are qualified, .,.ou must file an apRlication in writing on an approved form with the assessors, The filing deadline for an exemption under Mass. G,L. Ch, 59, ~5, Cis, (17, 17C 17C 1/2, 17D), lS, 22, 22A, 22B, 22C, 22D, 22E, (37, 37 A), (41, 41 B, 41 C), 42, 43 or (52), or a deferral under CIAl A is 3 months after the date tax bills were mailed. The filing deadline for all other exemptions under Ch. 59, ~5C is February 1, 2000 if tax bills were mailed on or before December 31,1999, or May 1, 2000, or 30 daiS after the date tax bills were mailed, whichever is later, if the tax bills were mailed after December 31, 1999, The filing deadline for a residential exemption under Ch, 59, ~5C, if locally adopted and not shown on your bill, is 3 months after the date tax bills were mailed. Applications are considered filed when received by the assessors, If your application is not received by the applicable deadline, the assessors cannot by law grant an abatement or exemption. INQUIRIES: If you have questions on your valuation or assessment or on abatements or exemptions, you should contact the Board of Assessors. If you have questions on payments, you should contact the Collector's Office, Cali 800.451.1709 to reorder - Formunis 4aTRRECS 14E V.4, 1 /~-:- -- I -:~~ : \ From: Place First Class Stamp Here o Check here if change of address 11111I111I11I11I1...11.11111....1..111'11.11.11.1111 Your Organization P.O. Box 000 Any City, ST 00000-0000 [ ] I L J [ II L.J €> 11 L_J r-l L.J -'~ -11 0 'T1 0 0 Z r LJ --i 0 'T1 -l 0 :! :D en Q m 'T1 -l r )> -l 'U 0 0 Z < -<en m :D ogj )> 11 C-l Z :Il-< 0 00 ~ IC m:D m LJ 0:Il -l '^m =i -l -l C 0 :D Z en en m )> -l r C III m )> z < z m 0 r 11 en 0 Q 'U Z !'l L J LJ .-c TO OPEN -SLIDE FINGER UNDER THIS FLAP AND PEEL BACK .. YOUR ORGANIZATION FOURTH QUARTER PERSONAL PROPERTY TAX BILL TAXPAYER COPY THE COMMONWEALTH OF MASSACHUSETTS THIS FORM APPROVED BY THE DEPARTMENT OF REVENUE. Description Total Valuation Class FISCAL YEAR ,. < ".-.. Make check payable and mail to: Your Organization P.O. Box 000 Any City, ST 00000 Tax Collector: Jim Smith Office Hours: Mon - Wed 8:30AM - 4:30PM Thur 8:30AM - 7:30PM Fri 8:30AM - 1 :OOPM Class Personal Property $Tax/$1000 $23.36 Interest at the rate of 14% per annum will accrue on overdue payments until payment is made. In compliance with the law, I hereby demand of you payment of your fiscal year personal property tax. MISC 18,611,600 504 128 SYCAMORE LANE 19-255-0014 Personal Property Total Taxable Valuation: 18,611,600 Total Personal Property Tax: Preliminary Tax Billed: Less: Payments Net Actual Tax: Preliminary Balance: Actual Tax 3rd Otr: Actual Tax 4th Otr: Interest to May 1, 2000: $428,252.92 $208,356.86 $208,356.86 $219,896.06 $0.00 $109,948.03 $109,948.03 $0.00 11I11I" 1111/ 111"'11" 11111I" .11".11" '11"'" III JOHN DOE JANE DOE P.O. BOX 999 123 ANY STREET ANY CITY ST 00000-0000 I Total Due Now By May 1, 2000: $109,948.03 D 1234567890123456789012345678901234567890 YOUR ORGANIZATION FOURTH QUARTER PERSONAL PROPERTY TAX BILL RETURN WITH PAYMENT THE COMMONWEALTH OF MASSACHUSETTS THIS FORM APPROVED BY THE DEPARTMENT OF REVENUE. Make check payable and mail to: Your Organization P.O. Box 000 Any City, ST 00000 Tax Collector: Jim Smith Office Hours: Mon - Wed 8:30AM - 4:30PM Thur 8:30AM - 7:30PM Fri 8:30AM - 1 :OOPM Class Personal Property $Tax/$1000 $23.36 Interest at the rate of 14% per annum will accrue on overdue payments until payment is made. Oescription Total Valuation MISC 18,611,600 Class BOOK/PAGEF!SCAL Y-EA.R 504 13334 12592 2000 PROPERTY DESCRIPTION AND LOCATION LOCATION 128 SYCAMORE LANE PARCEL 19-255-0014 FISCAL YEAR BEGINNING JULY 1. 1999 AND ENDING JUNE 30. 2000 Personal Properly Total Taxable Valuation: 18,611,600 Total Personal Property Tax: Preliminary Tax Billed: Less: Payments Net Actual Tax: Preliminary Balance: Actual Tax 3rd Otr: Actual Tax 4th Otr: Interest to May 1, 2000: $428,252.92 $208,356.86 $208,356.86 $219,896.06 $0.00 $109,948.03 $109,948.03 $0.00 $109,948.03 ~ 1111..1111111...111..11'11'1.11...111..11...11.11..1 JOHN DOE JANE DOE P.O. BOX 999 123 ANY STREET ANY CITY ST 00000-0000 I Total Due Now By May 1. 2000: 1234567890123456789012345678901234567890 YOUR ORGANIZATION SCHOLARSHIP FUND OPTIONAL INFORMATION "on ,. , __~ Donor Name: MAIL TO: Your Organization Scholarship Committee Your Organization Town Hall 100 Any Street Any City, ST 00000 <i :> a. a. a: f- a " '" 'E ::> E (; lL Address: Check off the amount you wish to contribute and write the amount in the space provided. Your contribution is in addition to the property tax shown above. Make a separate check payable to: Your Organization Scholarship Fund ~ "tl (; ~ 3 m o " D Voluntary Contribution Amount is: 1$ "' " o o 00 ro u Amount of Contribution: $1.00 D $2.00 D $5.00 D $1 0.00 D Other