HomeMy WebLinkAbout2006-R-01RESOLUTION NO. 2006-R- /
BEFORE THE COMMON COUNCIL
FOR THE CITY OF JEFFERSONVILLE
IN THE STATE OF INDIANA
RESOLUTION AFFIRMING AUTHORIZING AGREEMENT FOR
AUTOMATIC DEPOSIT
STATE OF INDIANA DISTRIBUTIONS TO POLITICAL
SUBDIVISIONS BY EFT
WHEREAS, the City of Jeffersonville is a local governmental entity that
is eligible to apply for grant subsidies;
WHEREAS, before the City of Jeffersonville may apply for grant
subsidies, the appropriating body must provide for automatic deposit of funds;
WHEREAS, the Common Council believes it would be in the taxpayers
best interest to have the ability to apply for grant subsidies; and
NOW THEREFORE, BE IT HEREBY RESOLVED that the
Common Council for the City of Jeffersonville hereby affirms authorizing the
agreement for automatic deposit, State of Indiana Distributions to Political
Subdivisions by EFT.
Adopted this (~0k- day of ~'~O t,~xY'G~(i ,2006.
This Resolution shall be in~full force and effect from and after its
passage and approval. ~//
Passed this (~ day of~5~'~' '
Robert L. W~iz, Jr.
Presiding Officer
ATTEST:
Clerk and Treasurer
Presented by me as Clerk and Treasurer to the Mayor of said City of
Jeffersonville this I('-~'~-day ortho ~2(i~. 2006 at /r~oO
Peggy ~¢~a'e)r
Clerk and Treasurer
his Resolution
006.
approved and signed __ day of
Robert L. Waiz,. , Mayor
AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSIT
STATE OF INDIANA DISTRIBUTIONS TO POLITICAL SUBDIVISIONS BY EFT
State Form 49002 (7-g8) / Generat Form No. 36
Approved by State Board of Accounts, 1998
The information contained on this form is CONFIDENTIAL according to lC 5-14-3-4(a)(5).
INSTRUCTIONS:
f, Prepare a separate form for each different state distdbut~Un your fiscal body elected to receive by electronic transfer of funds,
2. Political subdivision will complete first part and refer to a designated depository
3. Designated depository will complete second part and return to the political subdivision.
4. Political subdivision will fifa completed form with Auditor of State, 240 State House, Indianapolis, tN 46204
5. Political subdivision and depository should retain a copj4 Blank forms are available from Auditor ef State, Telephone: (3 f 7) 232-3300.
Co #
Corp #
~all 2 digit distributions
POLITICAL SUBDIVISION'S REQUEST AND AUTHORIZATION
On , the fiscal body~of
elected, pursuant to lC 4-8.1-2-7(c), to receive the State distribution for
by means of an electronic transfer of funds.
In compliance with the aforementioned election, this is to (1) request the Auditor of State to have the Treasurer of State initiate deposits, by electronic
transfer of funds, to the demand or savings account in the designated depository named herein and (2) authorize the designated depository to deposit
and credit to the account identified herein the amounts transferred electronicaJly. The political subdivision may revoke or cancel this request and authodzstion
by official, written notification to the Auditor of State, with a copy to the designated depository,
[] Demand (checking) [] Savir~gs
DEPOSITORY APPROVAL
The above is satisfactory and the undersigned designated depository agrees to accept such automated deposits.
Address (numt~er and street, city, state, ZiP code)
Date (month, day, year) litleAUth°dzed signature of depository
ABA Trans-Routing number
I Fiscal Body (lC 36-1-2-6) means:
(1) County council, for a county not having a consolidatad city;
(2) City-county council, for a consolidated dty or county having a consolidated
2 Fiscal Officer (IC 36-1-2-7) means:
(1) Auditor, for a county;
(2) Controller, for a consolidated city or second class city;
(3) Clerk-treasurer, for a third class city;
(4) Clerk-treasurer, for a town; or
(5) Trustee, for a township.
(1) Treasurer (lC 20-5-3-1), for a school corporation; or
(2) Treasurer (lC 20-14-2-5), for a public library.
[] Add Deposit [] Change Deposit
[] Stop Deposit IName:
Name of Vendor/Claimant who prepared this Request
Work Number:
STATE OF INDIANA
AUTOMATED DIRECT DEPOSIT AUTHORIZATION AGREEMENT
Instructions:
1. Requester wilt complete first section and have their bank/credit un~on completa Section 2.
2. The bank/credit union wil; complete Section 2 and return to the requestor.
3. Requestor will rite completed form with Auditor of State, 200 West Washington St., Room 240, Indianapolis, IN 4620z--2728
4. Requestor and depository should retain a copy, Additional blank copies are available from Auditor of State. Phone: (317) 232-3300
SECTION 4: REQUEST AND AUTHORIZATION
Home Number:
Vendor / Claimant as shown on the account
Federal I.D, Number I Social Security Number
Address (Number and Street, and/or P.O. Box No.) City, State, and Zip Code (00000-0000)
requests, pursuant to lC 4-8.1-2-7(d), to receive payment(s) by means of an electronic transfer of funds, and authorizes the
same under the terms stated herein.
It is understood by the undersigned VendodClaimant that, if approved, the Auditor of State may authorize the
Treasurer of State to: (1) initiate credit (deposits) in various and varying amounts, by e[ectrenic transfer of funds through
automated clearing house (ACH) processes, to the below listed checking (demand) or savings account designated in the
depository named below, and, (2) if necessary, to initiate debit entries or adjustments solely to correct any credit error
resulting from a deposit/credit entry that was made under this authorization. The VendodClaimant may revoke or cancel
this request and authorization by notifiJing the Auditor of State in writing at least fifteen (15) days pdor. Any change to the
account or to a new financial institution will require a new State of Indiana Automated Direct Deposit Authorization
Agreement. Failure to timely notify the Auditor of an account change will delay payment.
Name of Depository:
Type of Account: [] Checking (Demand)
Depository Account Number:
Date
[] Savings
Signature of Vendor / Claimant
SECTION 2: DEPOSITORY'S APPROVAL
The above is satisfactory and the undersigned designated depository agrees to accept such automated deposits.
Name of Depository: Phone: (
Address:
(Number and Street, and/or P.O. Box No.)
(City, State, and Zip Code (00000-0000)
Date
, 20__
Depository's Authorized Signature
Title
AaA Transit-Routing Number