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~ Equitable Sharing Agreement and Certification OMS Number 1123-0011 Expires 7-31-2011 o Police Department G> Sheriff's Office 0 Task Force (Complete Table A, page2) o Prosecutor's Office 0 Other (specify) Agency Name: Cass County Sheriffs Office NCIClORI/Tracking Number: N D 0 0 Street Address: 211 9 St S - PO BOX 488 City: Fargo Contact: Title: Capt Contact Phone: State: ND Zip: 58107-0488 First: Richard Last: Majerus 701-241-5813 Contact Fax: (701) 241-5805 Contact e-mail: MajerusR@casscountynd.gov Last Fiscal Year End (mm/dd/yyyy): I 12/31/2008 I o New Participant: Read the Equitable Sharing Agreement (page -') and sign the Affidavit (page -') G> Existing Participant: Complete the Annual Certification Report, read the Equitable Sharing Agreement (page -'), and sign the Affidavit (page -') o Change in Administration: Select to report change to Agency or Governing Body head DURING the current fiscal year. Read the Equitable Sharing Agreement (page -') and sign the Affidavit (page -'). Revise the Annual Certification Report, read the Equitable Sharing Agreement (page -'), and sign the Affidavit (page -'). o Amended Form: Annual Certification Report Summary of Equitable Sharing Activity Justice Funds Treasury Funds 1 Beginning Equitable Sharing Fund Balance (must match $0.00 $0.00 Ending Equitable Sharing Fund Balance from prior FY) 2 Federal Sharing Funds Received $0.00 $0.00 3 Federal Sharing Funds Received from Other Law Enforcement Agencies and Task Forces (complete Table Bf page -') 4 Other Income $0.00 $0.00 5 Interest Income Accrued $0.00 $0.00 D Check box if non-interest-bearing account. 6 Total Equitable Sharing Funds (total of lines' - 5) $0.00 $0.00 7 Federal Sharing Funds Spent (total of lines a - n below) $0.00 $0.00 8 Ending Balance (subtract line 7 from line 6) $0.00 $0.00 Page' of 5 January 2009 Version 1.5