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.
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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:
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FOR M U N I 5 ,.
CITY OF WINTER SPRINGS, F1L
Estimated Costs for Installation
November 17, 2000
Page One
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etForm Central Pro™ Software
Limited license restricted to output from the MUNIS application software only.
Includes Munis integration and supporting software.
$ 4,500.00 ./
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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,
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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.
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Postal Software
2,995.00
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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 @ .-" '-<>~
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Additional PCMCIA Signature Card Mo
Includes the same two signatures as original card. Additional signatures can be purchased at a cost~.OO each.
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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!
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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,
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.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).
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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.
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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.
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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
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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
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SITE PLAl'v FOR INSTALLATION
CITY OF I~INTER SPRINGS, FL
NO~'EMBER 17, 2000
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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.
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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.
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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.
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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.
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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.
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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
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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.
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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.
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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.
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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.
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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.
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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
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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.
.
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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$
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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.
.
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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
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FORMUNIS JOB MANAGEMENT FEATURES
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Output Management
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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.
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Laser to Mail includes
HP 4050 (1000/Hour)
NT Workstation or Server
FORMUNIS Applications
GUI Forms Control
JETFORM OUTPUT FILE
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OUTPUT
FILE
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~Postal Sorting
1"1.1.1.1.1,,,11
E-mail (Future)
UNIX
MUNIS Applications
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Form with Adobe
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Lexmarl< Printer
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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
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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
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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?
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FORMUNIS,.
FORMUNIS
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Forms Processing Equipmen
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Laser to Mail
FS 130 Folder/Sealer
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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
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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.
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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.
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100
13.75Ibs,
100
1,600 letters per hour
10,000 Monthly
661bs,
$ 7,695,00
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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
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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
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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
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MUNIS
Software Application
Signature Card
Laser Printer
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Secu rity
the Way You Want It
Electronically
Signed Form
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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
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For those who thi
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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.
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FORMUNIS~
Optimize m ~
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~~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.
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· Save time on mail preparation and increase your response rates.
. Complete Database Management
· Merge/Purge Tools
· Easy to use with Windows Design and "wizards"
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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
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AGEMENT SYSTEM
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purchase orders, a \:l invoices.
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as you print J
or even archivej9stead of printing.
Automatically'generates one output
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fileJor'each document for
quicksearching and retrieval.
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Electronic D6cument
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Management System (EDMS).
The ArchiveModule outputs
to-anyEDMS that can import
an ASCII index file.
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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
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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!
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LaserJet 2100/2100M/2100TN I
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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
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LaserJet 4050 Series
Printers
r; HP
\j 17l~g~~r-minute black-and-white network printers.
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Redefining workgroup printing with
innovative soLutions.
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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
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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
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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
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( HP Printers
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\ 32-'pagJper-minute, high-volume black and white
\ rk I .
netwo. 'pnnters.
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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,
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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
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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
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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
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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
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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
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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
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SUeSEQUENT COl.lECTING BAII'K USE ONL Y
Your Organization
P.O. Box 000
Any City, ST 00000
Payroll Account
FORMUNIS,. ....
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***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
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_~a!rlings
____._._2., _ ..,().eductions
REGULAR .25,1703
EDINC
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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
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CBRET 7%
1,814.78
1,562.80
196.94
96.48
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NET PAY
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1,814.78
882.50
932.28
AccruaL\,JsClge,. .
SICK(H) 0.00
VACAIH) 0.00
PERS 0,00
~ema,ining Balance,
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7.38
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TAXABLE GROSS
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HAVE A WONDERFUL WEEKEND
NEW INSURANCE FORMS ARE NOW AYAILABLE IN THE ADMINISTRATORS OFFICE
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Your Organization
P,O. Box 000
Any City, ST 00000
002110
PRESORTED
FIRST.CLASS MAIL
U.S, POSTAGE PAID
PORTLAND, .ME
PERMIT NO.4
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ADDRESS SERVICE REQUESTED
11I11I1111I11...111..11...1111.11...111111111.1111I1
ABC SUPPLY
123 AUBURN STREET
PORTLAND, MAINE 04101
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DEPOSITORY BANK ENDORSEMENT
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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
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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. _
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001 EACH HON 7707 HIGH PERFORMANCE TASK
CHAIR W/FABRIC #10 BLACK. PRICE CODE
III
3.0
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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,
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VILLAGE CLERK
VILLAGE OF FORMUNIS
99 ANY COURT
ANYTOWN, ST 00000
Delivery Flefere"ce.
MARY SMITH
Cost Each
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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
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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.
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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
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1500 CENTRAL AVENUE
ANYCITY, ST 11111-2222
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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
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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':
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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
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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
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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
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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
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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
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10 Dependent care benefits
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11 Nonqualified plans
12 Benefits included in box 1
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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
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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
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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
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PAYER'S name, street address, city, slate, Zip code, and telephone no,
YOUR ORGANIZATION
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$
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$
2 Royallies
3 Other income
(800) 451-1709
$
FORM 1099-MISC
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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
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Department Of the Treasury. Internal Revenue Service
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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.
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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
.$................................._.............._................ ....................................................................... $
$ '$......_........................._."_...........
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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
.$................. -...-.........-............. ................... ....................................................................... $
$ '$...................................................
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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
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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
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40600 1 1/23/99
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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 -,.. . . .
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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:
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Stamp Here
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Meter Reading
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12/01/00
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Bill Date
11/23/00
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OS/27/2000
2912
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PRESORTED
FIRST-CLASS MAIL
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1 OUNCE
YOUR 5T A TE
PERMIT NO.1
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John Doe
Jane Doe
P.O. Box 999
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Code Date Read Meter Number Usage Charge CTl _. ;:+
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This Billing
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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,
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E-3-140-004
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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
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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
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JOHN DOE 789 ANY STREET
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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 .. . . .
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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
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Description
WATER NMTR
SEWER NMTR
SWRNMT CAP
WTRNMT CAP
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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
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Charge
83,20
138.24
12.75
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. Current Charges
250,19
Past Due Interest
.00
al Past Due
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. .
$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
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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
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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
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3 \)0 _~g e
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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
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PAST DUE
CURRENT CHARGE
AMOUNT DUE
NOW
Please write your Account No. on your check
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If VOl! have OUFSTIONS
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AboUl ICdl Telenhone
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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
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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
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_,~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
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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
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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
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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
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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
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From:
Place
First Class
Stamp Here
o Check here if change of address
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Your Organization
P.O. Box 000
Any City, ST 00000-0000
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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
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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
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Voluntary Contribution
Amount is:
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Amount of Contribution:
$1.00
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$2.00
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$5.00
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$1 0.00
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