FY2014/2015 Special District Fee Invoice And Update form FLORIDA DEPARTMENT OF ECONOMIC OPPORTUNITY Invoice No.: 32765 Date Invoiced: 07/2112015
FY 2014/2015 SPECIAL DISTRICT FEE INVOICE AND UPDATE FORM Special District Accountability Program
Instructions:In accordance with Sections 189.064 and 189,018, F.S., and Chapter 73C-24, F.A.C., please remit the fee due payable to the
Department of Economic Opportunity OR complete the Zero Annual Fee Certification Section, as appropriate. In addition, review the
information below about the district and update as necessary. Provide backup documentation if the district's name or status has changed.
By the postmarked due date, mail the payment and this signed form to the Department of Economic Opportunity, Office of Financial Mgmt.,
107 E. Madison Street, MSC 120, Tallahassee, Florida 32399-4124. Direct questions to(850) 717-8430.
ANNUAL FEE: $125.00 LATE FEE: $0.00 RECEIVED: $0.00 FEE DUE, POSTMARKED BY 09/20/2015: $125.00
District's Name, Registered Agent&Office*:
City of Edgewater Community Redevelopment Agency Telephone: (386)424-2400
Ms. Samantha Bishop Fax: (386)424-2469
City of Edgewater Status*: Dependent
104 North Riverside Drive Creation Document: On File
Edgewater, FL 32141 Map: On File
Last Update:07/21/2015
Website: www.edgewatercra.org
E-mail: sbishop @cityofedgewater.org
County(ies): Volusia
Local Governing Authority*: City of Edgewater
Function(s)*: Community Redevelopment
Date Established: 03/02/2015
Creation Documents*: City Resolutions 2015-R-08 and 2015-R-09
Statutory Authority*: Chapter 163, Part III, Florida Statutes
Board Selection*: Same as Local Governing Authority
Authority to Issue Bonds*: Yes
Revenue Source*: Tax Increment Financing
*Explanations
Registered Agent: The person designated by the special district to accept due process on behalf of the special district
Status: Independent or Dependent- see Section 189.012, F.S.
Local Governing Authority: The governing body of a unit of local general-purpose government
Functions: The function/purpose of the special district
Creation Documents: Ordinance, Resolution, Statute, Special Act, Court Decree, Interlocal Agreement. etc.
Statutory Authority: The Florida Statute governing the function of the special district
Board Selection: Appointed,Appointed/Ejected, Elected, Governor Appoints, Local Governing Authority Appoints Sa me a
�I �ovem_ ing Authont , Similar to Local Governing Authority, Other
Authority to Issue Bonds: e r No
Revenue Sources: Ad Valorem, Agreement, Assessments, Bond Issuer Fees, Co., Donations, Fed, Fees, Other _vestments,
Grants, Municipality, Non-Ad Valorem, Priv. Enterprise, Sales Surtax, Sales/Leases, State IF)Tolls, None
CERTIFICATION: I, the undersigned registered agent, do hereby certify that the information above is accurate and complete as of
this date. It does or does not need to be changed.
Registered Agent's Signature:', i��(rtiNl "�1[�- J (`N Date: 7- 9 -15
I "r'
ZERO ANNUAL FEE CERTIFICATION SECTION- If eligible, the special district may request a zero annual fee instead of making a
payment by having the registered agent certify to the following:
1. This special district is not a component unit of a general purpose local government as defined in the Governmental Accounting
Standards Board's Statement No. 14, issued in June 1991 effective after December 15, 1992, as amended.
2. This special district is in compliance with the reporting requirements of the Department of Financial Services.
3. This special district reported $3,000.00 or less in annual revenues to the Department of Financial Services on its Annual Financial
Report for Fiscal Year 2013/2014(special districts created after that fiscal year must attach a current income statement verifying
$3,000.00 or less in revenues for the current fiscal year).
4. This certification will be returned to the Department at the address above postmarked by 09/20/2015 and,
5. This special district understands that if the Department determines any of these items to be inaccurate, this special district must
pay the appropriate fee when invoiced. The Department will verify these statements within 30 days of receiving this form.
I,the undersigned registered agent, do hereby certify that to the best of my knowledge and belief, ALL of the above statements contained
herein and on any attachments hereto are true, correct, complete, and made in good faith as of this date. I understand that any
information I give may be investigated and verified with the Department of Financial Services and the Auditor General.
4.
I
, ■rs.
City of
of
rD G Inc.1951ATER
July 29, 2015
Mr. Jack Gaskins Jr.
Special District Accountability Program
Florida Department of Economic Opportunity
Office of Financial Management
Caldwell Building
107 E. Madison Street
Tallahassee, FL 32399
Dear Mr. Gaskins,
Thank you for sending the Special District Fee Invoice and Update Form. The City of
Edgewater Community Redevelopment Agency is requesting the Zero Annual Fee for this
fiscal year. Please find the attached Annual Report showing zero revenues for this fiscal
year 2014 — 2015.
Thank you for your assistance.
Be t Regards,
I. I
Samantha Bishop (6,6:614
Economic Development/ Redevelopment Coordinator
Al
EDGEWATER CRA
P.O. Box 100 • Edgewater, FL 32132-0100
(386)424-2400 Ext. 1330 • Fax(386)424-2409
e-mail: sbishop@cltyofedgewater.org
www.edgewatercra.org
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