Fiscal Year, April 1, 2008 to March 31, 2009 or October 1, 2007 to September 30, 2008 Calendar Year, January 1 to December 31, 2008
A1.1 Legal Name of Municipality, Local Services Board or First Nations Band A1.2 Mailing Address A1.21 City / Town A1.22 Postal Code A1.3 Street Address (if different from mailing address) A1.4 Web Site Address
A2.1 Name (First Name) Last Name A2.2 Telephone A2.3 Fax A2.4 E-mail Address
A3.1 Name (First Name) Last Name A3.2 Telephone A3.3 Fax A3.4 E-mail Address
B1.1 Surplus B1.2 Deficit B1.3 NilAmount $
B2.1 Provincial Operating Funding (e.g. public library operating grant or First Nations band operating grant) B2.1 $ Amount B2.2 Local Funding B2.2 $ Amount B2.5 Donations (monies donated by outside bodies, e.g. Trust Funds, etc.) B2.5 $ Amount B2.8 Other (Specify any other source of funds not included above and indicate the amount received from each funding source listed) B2.8 $ Amount Other (Specify any other source of funds not included above and indicate the amount received from each funding source listed) $ Amount Other (Specify any other source of funds not included above and indicate the amount received from each funding source listed) $ Amount Other (Specify any other source of funds not included above and indicate the amount received from each funding source listed) $ Amount Other (Specify any other source of funds not included above and indicate the amount received from each funding source listed) $ Amount Other (Specify any other source of funds not included above and indicate the amount received from each funding source listed) $ Amount
B2.9 Total Operating Revenues B2.9 $ Amount
B4.8 Funds returned to government sources B4.8 $ Amount B4.9 Contract payments made to library boards for library services (Specify the library board and amount given to each board) B4.9 $ Amount Contract payments made to library boards for library services (Specify the library board and amount given to each board) $ Amount Contract payments made to library boards for library services (Specify the library board and amount given to each board) $ Amount Contract payments made to library boards for library services (Specify the library board and amount given to each board) $ Amount Contract payments made to library boards for library services (Specify the library board and amount given to each board) $ Amount Contract payments made to library boards for library services (Specify the library board and amount given to each board) $ Amount B4.10 Other (Specify all other expenditures not reported above and indicate the amount spent for each expenditure listed) B4.10 $ Amount B5.0 Total Operating Expenditures B5.0 $ Amount
This annual report is filed by the undersigned pursuant to the Public Libraries Act, R.S.O. 1990, C.P. 44 for the fiscal year
The Municipality, Local Services Board or First Nations Band during the reporting period herewith, accepts the above report, certifies its essential accuracy and transmits it to the Ministry of Culture in accordance with the above statute and consents to the release of the information contained in the report pursuant to subsection 17(3) of the Freedom of Information and Protection of Privacy Act, R.S.O. 1990, chapter F.31, as amended.Signature of Authorized Official Print Name of Authorized Official Date
Please submit two (2) signed copies of the Annual Survey for municipalities, local services boards and First Nations Bands that contract for library service to:Programs and Services BranchMinistry of Culture400 University Avenue, 4th FloorToronto ON M7A 2R9
34–062 (Rev. 2009/03) © Queen’s Printer for Ontario, 2009