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~ ~ <br />~,..,, ,~ <br />-- . } Ec~~c~aE~~~ ~f~arirli <br />F .,~ -+ .~ <br />y.,, .. G~C~C~jC~tEC~CI <br />_.~-" <br />/~ ~ U~ (/ V~ 1 .r- <br />- / OMB Numner 11?3-UU1 "i <br />Expires %-;1-2U"11 <br />Police Department ~ Sheriff's Office ~TasE: Force (Complete Table A, page 2~ <br />J Prosecutor's Office G Other (specif~r) <br />Qgene~~ Name: North Olmsted Police <br />NCICIORiITracEcing Number: O g 0 1 8 3 4 0 0 <br />Street ~oddres5: 27243 Lorain Rd. <br />City: North Olmsted <br />Contact: Title: Captain <br />Contact Phone: 440-777-3535 <br />First: Jamie <br />State: OH Zip: 44O7U <br />Last: Gallaher <br />Contact Fax: (440) 777-9189 <br />Contact e-mall: gallagherj(ciJ,north-olmsted.com <br />Last Fiscal Year End (mmlddl~yy}~): 12/31/2008 <br />O New Participant: Read the Equitable Sharing Agreement (page 4) and sign the Affidavit (page 5) <br />O Existing Participant: Complete the Annual Certification Report, read the Equitable Sharing Agreement <br />(page 4), and sign the Affidavit (page 5) <br />O Change in Administration: Select to report change to Agency or Governing Body head DURING the current fiscal <br />year. Read the Equitable Sharing Agreement (page 4) and sign the Affidavit (page 5). <br />O Amended Form: Revise the Annual Certification Report, read the Equitable Sharing Agreement (page <br />4), and sign the Affidavit (page 5). <br />~,~~e~~~ ~e~~~~c~~ic~~ ~~~c~~ <br />Justice Treasury <br />~......,..,,.... ,.f C..~~i+~hla Charinn ACtIVItY Funds Funds <br /> <br />~ Beginning Equitable Sharing Fund Balance (must match <br />Ending Equitable Sharing Fund Balance from prior FY) 5;0.00 $10.00 <br /> <br />2 Federal Sharing Funds Received $10.00 $0.00 <br /> <br />3 Federal Sharing Funds Received from Other Law Enforcement <br />Agencies and Tasl: Forces (complete Table B, page 2) <br />q Other Income $0.00 $10.00 <br /> <br /> <br />5 Interest Income Accrued <br /> <br />(~ checl; ifnon-interest-bearing account) $0.00 $0.00 <br />6 Total Equitable Sharing Funds (total of lines 1 - 5) <br />$0.00 <br />510.00 <br /> <br />7 Federal Sharing Funds Spent (total of lines a - n below) <br />X0.00 <br />$0.00 <br /> <br />8 <br />Ending Balance (subtract line 7 from line 6) $0.00 $0.00 <br />Page 1 of 5 <br />January-2009- - <br />Version 1.4 <br />