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tr�f � OMB Number 1123-0011 <br /> �° fP Expires 9-30-2014 <br /> Equitable Sharing <br /> .441ti <br /> Agreement and <br /> Certification <br /> 0 Police Department ® Sheriff's Office 0 Task Force(Complete Table A) <br /> 0 Prosecutor's Office 0 National Guard Counterdrug Unit 0 Other <br /> *Please fill each required field. Hover mouse over any fillable field for pop-up instructions. <br /> Agency Name:Cass County Sheriffs Office <br /> NCIC/ORI/Tracking Number: N D 0 0 9 0 0 0 0 <br /> Mailing Address: 211 9th Street South <br /> City: Fargo State: ND Zip: 58103 <br /> Finance Contact: First:Mary Last: Matheson <br /> Phone:7012415610 E-mail: mathesonm @casscountynd.gov <br /> Preparer: First:Michele Last: Harmon <br /> Same as Phone: 7012415800 E-mail: harmonm @casscount nd. ov <br /> Finance Contact y g <br /> Independent Public Accountant: E-mail: dmix@nd.gov <br /> Last FY End Date: 12/31/2013 Agency Current FY Budget: $6,127,821.00 <br /> Q New Participant: Read the Equitable Sharing Agreement and sign the Affidavit. <br /> 0 Existing Participant: Complete the Annual Certification Report,read the Equitable Sharing Agreement,and sign <br /> the Affidavit. <br /> Q Amended Form: Revise the Annual Certification Report,read the Equitable Sharing Agreement,and sign <br /> the Affidavit. <br /> Annual Certification Report <br /> Summary of Equitable Sharing Activity Justice Funds' Treasury Funds' <br /> 1 Beginning Equitable Sharing Fund Balance(must match <br /> Ending Equitable Sharing Fund Balance from prior FY) <br /> 2 Federal Sharing Funds Received <br /> 3 Federal Sharing Funds Received from Other Law Enforcement <br /> Agencies and Task Forces(To populate,complete Table B) <br /> 4 Other Income <br /> 0 <br /> 5 Interest Income Accrued Non-Interest Bearing <br /> Interest Bearing Qi <br /> 6 Total Equitable Sharing Funds(total of lines 1 -5) $0.00 $0.00 <br /> 7 Federal Sharing Funds Spent(total of lines a-m below) $0.00 $0.00 <br /> 8 Ending Balance(difference between line 7 and line 6) $0.00 $0.00 <br /> Justice Agencies are:FBI,DEA,ATF,USPIS,USDA,DCIS,DSS,and FDA. <br /> 2 Treasury Agencies are:IRS,ICE,CBP,TTB,USSS,and USCG. <br /> Page 1 of 5 October 2012 <br /> Version 2.1 <br />