State Fiscal Year 2017 *** Reporting Period: July 1, 2016 to June 30, 2017
Report due no later than OCTOBER 1 following each fiscal year. The Utah Substance Abuse Advisory Council may suspend future payments to an agency for not filing a completed report or failing to use the monies in compliance with §32B-2-403 and 404.
Name of County:Name and Title of Contact Person (print):
Contact’s Phone Number:
/ Mailing Address (street, city, zip code):
Contact’s E-mail Address:
Contact’s Fax Number:
1. / Unspent Beer Tax Funds carried forward from prior year(s): / $
2. / Amount of State Fiscal Year 2017 Beer Tax Funds Distributed to the County (see FY 2017 Distribution located at www.usaav.utah.gov): / $
3. / List each municipality where funds were defaulted to the county included in (2) above (see FY 2017 Distribution for complete listing):
4. / Beer Tax Funds SPENT IN FISCAL YEAR 2017, ALLOWABLE USES BY CATEGORY / Amounts Spent In Each Category
(Report only categories that were in the Approved Plan)
a. / Alcohol-Related Prevention: / a. $
b. / Treatment of Offenders with Alcohol Problems: / b. $
c. / Alcohol-Related Law Enforcement: / c. $
d. / Prosecution of Alcohol-Related Cases: / d. $
e. / Confinement of Alcohol Law Offenders: / e. $
5. / TOTAL FUNDS EXPENDED In State Fiscal Year 2017 (Add Lines a through e): / $
6. / BALANCE OF FUNDS CARRYING FORWARD to Next Fiscal Year (Total Lines 1+2 minus Line 5) / $
7. PERFORMANCE INDICATORS (required): Include performance indicators from the program(s) and/or project(s) that received Beer Tax Funds (see guidelines at www.usaav.utah.gov for examples of indicators). These are the measurable outcomes that determine whether the funded program(s) and/or project(s) produced the desired result.
Chief Executive Officer (CEO print name & title)
/ CEO Telephone
/ CEO E-mail Address
As chief executive officer, I do hereby attest the Beer Tax Funds received were used exclusively for programs and projects outlined in §32B-2-403 and 404, and were utilized to supplement any monies otherwise appropriated or available for the local government’s use for programs and projects described in §32B-2-403 and 404, and were not used to supplant existing funds.
______
CEO Signature (Commissioner, County Council Member, or County Mayor) / ______
Date
CEO MUST SIGN THE FORM OR IT WILL BE RETURNED
Please send completed reports to: CCJJ – ATTN: Collett Litchard, Utah State Capitol Complex – Senate Building, Suite 330, P.O. Box 142330,
Salt Lake City, UT 84114-2330 | E-mail Telephone: (801) 538-1031 Fax: (801) 538-1024
INSTRUCTIONS TO COUNTIES
FOR COMPLETING FY 2017 BEER TAX FUNDS ANNUAL REPORT
TOP SECTION:
Complete the top section by providing the name of the county for which you are reporting, the contact information including name/title, mailing address, email address, telephone and fax numbers for the contact person.
Line #1
You are allowed to carry forward unspent Beer Tax Funds from prior years. If you have any unspent funds, identify the amount in the box on the right side of Line 1.
Line #2
Place the amount of your county’s distribution received for FY 2017 in the box on the right side of Line 2.
You should have a separate account code/restricted line item on the county budget showing the amount that was distributed. Also, you can obtain the total amount from the FY 2017 Distribution document located on the Utah Substance Abuse Advisory Council’s (USAAV) web page at www.usaav.utah.gov.
*NOTE: You will need to know the municipalities who elected to have funds default to your county. The amount is included in the total distribution.
Line #3
List the name(s) of each municipality electing to have funds default to your county. You can find this list on the USAAV web page titled “FY 2017 Distribution.” The entities highlighted in blue under your County name have been included in the County distribution.
Lines #4a through 4e
This section is where you report the ACTUAL amounts spent in each category. Please remember to only report in the categories that were approved in the FY 2017 Plan that you previously filed with USAAV. List the dollar amounts in the blue box titled “Amounts Spent in Each Category” on lines 4a through 4e.
Line #5
Add the amounts identified in Section 4, lines a, b, c, d, and e. Place the total in the blue box on the right side of Line 5.
Line #6
Add Lines 1 and 2 together and subtract Line 5 from that amount to arrive at the balance of unspent Beer Tax Funds that will be carried forward to the next State fiscal year (July through June).
Line #7
Include Performance Indicators of whether the program(s) or project(s) that received funds were effective. We have included some examples of Performance Indicators in the Guidelines document located on the USAAV web page. Generally, we are looking for the results from each category of spending. You can also expand on constraints that factored into a less-than-successful program/project and any changes you will make for the next year.
BOTTOM SECTION
Print the name/title of the county’s CEO. Provide the telephone number and email address. Please note that the CEO is a County Commissioner, County Council Member, or County Mayor.
Return the completed FY 2017 Beer Tax Funds Annual Report for Counties to the address listed on the bottom of the form or scan and email to .