The MS-965 form, as revised in September 2013, serves as a comprehensive annual use report for state funds by municipal entities, specifically detailing expenditures for a variety of public works and maintenance activities. This form encompasses a spectrum of expenditure categories ranging from minor and major equipment purchases to winter maintenance services, and from street lighting to highway construction projects. It requires detailed reporting on the initial and actual balances in the Municipal Liquid Fuels Tax Fund, alongside receipts from state funds, turnback allocations, interest on investments, and other miscellaneous sources. The form further outlines the total funds available, allocating specifics on equipment purchases and adjustments approved by the Pennsylvania Department of Transportation (PennDOT). Additionally, it extends to include depository information, ensuring transparency and accountability in municipal spending. Highlighting its importance in fiscal oversight, the form mandates certification by the relevant municipal authority, underscoring the necessity of accuracy and diligence in reporting state fund utilization. Through its structured categories and detailed reporting requirements, the MS-965 form plays a pivotal role in managing and tracking public fund expenditure, thereby facilitating efficient and effective use of state-allocated resources for municipal improvements and services.
| Question | Answer |
|---|---|
| Form Name | Ms 965 Form |
| Form Length | 7 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min 45 sec |
| Other names | ms 965 form download, form 965, pa form ms 965, pa ms965 |
(Rev 9/13) |
ACTUAL USE REPORT
OF STATE FUNDS
YEAR
EXPENDITURE SUMMARY |
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DOT USE ONLY |
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TYPE OF WORK |
BUDGET |
AMOUNT |
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ITEM # |
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Minor Equipment Purchases |
430.26 |
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Computer / Computer Related Training |
430.27 |
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Major Equipment Purchases |
430.74 |
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Agility Projects |
430.99 |
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Street Cleaning and Gutters |
431 |
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Winter Maintenance Services |
432 |
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Traffic Control Devices |
433 |
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Street Lighting |
434 |
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Storm Sewers and Drains |
436 |
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Repairs of Tools and Machinery |
437 |
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Maintenance and Repairs - Roads and Bridges |
438 |
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Highway Construction and Rebuilding Projects |
439 |
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Miscellaneous |
MISC |
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TOTAL EXPENDITURES:
BEGINNING BALANCE
ACTUAL BALANCE IN MUNICIPAL LIQUID FUELS TAX FUND ON JANUARY 1st,
RECEIPTS
STATE FUNDS CURRENT YEAR (ACT 655)
TURNBACK ALLOCATION (ACT 32)
INTEREST ON INVESTMENTS
REIMBURSABLE AGREEMENTS
MISCELLANEOUS RECEIPTS
TOTAL RECEIPTS:
REMAINING FUNDS AVAILABLE AS OF DECEMBER 31ST, __________
Beginning Balance plus Total Receipts
PREVIOUS YEAR'S EQUIPMENT BALANCE
THIS YEARS EQUIPMENT ALLOCATION
PENNDOT APPROVED ADJUSTMENTS
TOTAL MONIES AVAILABLE FOR MAJOR EQUIPMENT
AMOUNT EXPENDED FOR MAJOR EQUIPMENT
REMAINING EQUIPMENT BALANCE
EQUIPMENT BALANCE CARRIED FORWARD TO NEXT YEAR'S REPORT
BALANCE FROM PREVIOUS YEAR
ALLOCATION YEAR |
STATE FUNDS ALLOCATION (ACT 655) |
ALLOCATION YEAR |
TURNBACK ALLOCATION (ACT 32) |
TOTAL - TO BE BUDGETED IN STATE FUNDS COLUMN
ITEM
GENERAL FUNDS
STATE FUNDS
TOTAL
Expenditure Summary Total
Tax Levied for Roads and General Municipal Purpose |
mills or other source |
(Rev 9/13) |
DEPOSITORIES
CONTACT AND BONDING
YEAR
ACCOUNT NUMBER |
DEPOSITORY NAME |
YEAR END BALANCE |
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1. |
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2. |
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3. |
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4. |
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5. |
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6. |
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7. |
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8. |
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9. |
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10. |
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DEPOSITORY TOTAL |
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OUTSTANDING DEPOSITS |
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OUTSTANDING CHECKS |
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RECONCILED DEPOSITORY TOTAL |
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We certify that the reported State Fund Receipts and expenditures are correct.
We the undersigned further Certify that ____________________________________________
(NAME) |
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or Treasurer of __________________________________________ |
____________________________________ |
(MUNICIPALITY NAME) |
(COUNTY) |
has been duly bonded in the amount of $ _______________________ by the ______________________________
(SURETY
for the year ending December 31, ___________
SECRETARY
MUNICIPAL ADDRESS
CITY, STATE ZIP
TELEPHONE NUMBER:
EMAIL ADDRESS:
FAX NUMBER:
OFFICE
HOURS
Home:Office:
(Rev 9/13) |
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Dormont Borough (02422)
INTEREST
2014
YEAR
DATE
DEPOSITORY
INTEREST AMOUNT
01/31/2014 |
PNC Bank - |
$1.02 |
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02/28/2014 |
PNC Bank - |
$0.08 |
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03/31/2014 |
PNC Bank - |
$5.06 |
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04/30/2014 |
PNC Bank - |
$3.63 |
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05/31/2014 |
PNC Bank - |
$3.43 |
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06/30/2014 |
PNC Bank - |
$3.46 |
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07/31/2014 |
PNC Bank - |
$3.25 |
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08/29/2014 |
PNC Bank - |
$2.79 |
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09/30/2014 |
PNC Bank - |
$2.94 |
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10/31/2014 |
PNC Bank - |
$2.75 |
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11/28/2014 |
PNC Bank - |
$2.51 |
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12/31/2014 |
PNC Bank - |
$2.75 |
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TOTAL
$33.67
(Rev 9/13) |
Dormont Borough (02422)
RECEIPTS
2014
YEAR
RECEIPT TYPE
DATE
PAYER
DESCRIPTION
PROJECT #
REIMBURSABLE
AGMT#
AMOUNT
Act 655 |
03/03/2014 |
Commonwealth of PA |
Liquid Fuels |
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$159,488.42 |
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Allocation |
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TOTAL |
$159,488.42 |
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(Rev 9/13) |
Dormont Borough (02422)
ACCOUNT EXPENDITURES
2014
YEAR
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CHECK / |
DATE |
PAYEE |
B.I. # |
SPLIT CHECK |
DISTRIBUTED |
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VOUCHER# |
PROJECT # |
AMOUNT |
AMOUNT |
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1084 |
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01/24/2014 |
Carghill Salt Division |
432 |
($29,325.42) |
($29,325.42) |
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1085 |
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01/24/2014 |
Duquesne Light |
433 |
($835.89) |
($835.89) |
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1086 |
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01/24/2014 |
Newman Traffic Signs |
433 |
($41.43) |
($41.43) |
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1087 |
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01/24/2014 |
Tippman Industrial |
433 |
($2,205.00) |
($2,205.00) |
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1088 |
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03/12/2014 |
Carghill Salt Division |
432 |
($27,129.21) |
($27,129.21) |
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1089 |
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03/12/2014 |
Duquesne Light |
433 |
($10,611.09) |
($3,343.56) |
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1089 |
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03/12/2014 |
Duquesne Light |
434 |
($10,611.09) |
($7,267.53) |
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1090 |
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03/12/2014 |
Kiefer Coal & Supply |
432 |
($542.11) |
($542.11) |
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Co |
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1091 |
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03/12/2014 |
Lowes Business Account |
432 |
($34.16) |
($34.16) |
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1092 |
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03/12/2014 |
Traffic Systems & |
433 |
($2,628.39) |
($2,628.39) |
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Services |
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1093 |
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03/12/2014 |
Verizon |
433 |
($29.22) |
($29.22) |
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1094 |
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03/19/2014 |
Carghill Salt Division |
432 |
($11,528.82) |
($11,528.82) |
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1095 |
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03/28/2014 |
Traffic Systems & |
433 |
($558.87) |
($558.87) |
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Services |
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1096 |
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03/31/2014 |
Carghill Salt Division |
432 |
($13,449.34) |
($13,449.34) |
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1097 |
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03/31/2014 |
Traffic Systems & |
433 |
($365.10) |
($365.10) |
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Services |
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1098 |
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04/11/2014 |
Duquesne Light |
433 |
($488.66) |
($488.66) |
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1099 |
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04/11/2014 |
Traffic Systems & |
433 |
($196.00) |
($196.00) |
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Services |
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1100 |
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04/11/2014 |
Verizon |
433 |
($59.74) |
($59.74) |
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1101 |
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05/09/2014 |
Traffic Systems & |
433 |
($431.52) |
($431.52) |
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Services |
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1102 |
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05/09/2014 |
Verizon |
433 |
($29.70) |
($29.70) |
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1103 |
05/22/2014 |
Duquesne Light |
433 |
($601.22) |
($601.22) |
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1104 |
05/22/2014 |
Traffic Systems & |
433 |
($249.55) |
($249.55) |
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Services |
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1105 |
05/30/2014 |
Traffic Systems & |
433 |
($473.45) |
($473.45) |
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Services |
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1106 |
06/13/2014 |
Duquesne Light |
433 |
($855.87) |
($855.87) |
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1107 |
06/20/2014 |
Traffic Systems & |
433 |
($395.50) |
($395.50) |
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Services |
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1108 |
07/11/2014 |
Traffic Systems & |
433 |
($7,889.04) |
($7,889.04) |
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Services |
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1109 |
07/11/2014 |
Verizon |
433 |
($30.14) |
($30.14) |
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1110 |
07/18/2014 |
Duquesne Light |
433 |
($855.87) |
($855.87) |
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1111 |
07/18/2014 |
Traffic Systems & |
433 |
($619.50) |
($619.50) |
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Services |
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1112 |
07/23/2014 |
TAPCO |
433 |
($205.23) |
($205.23) |
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1113 |
07/23/2014 |
Traffic Systems & |
433 |
($402.50) |
($402.50) |
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Services |
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1114 |
08/08/2014 |
Duquesne Light |
433 |
($855.87) |
($855.87) |
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1115 |
08/08/2014 |
Traffic Systems & |
433 |
($525.35) |
($525.35) |
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Services |
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1116 |
08/28/2014 |
Traffic Systems & |
433 |
($1,170.18) |
($1,170.18) |
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Services |
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1117 |
09/11/2014 |
Traffic Systems & |
433 |
($168.00) |
($168.00) |
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Services |
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1118 |
09/11/2014 |
Verizon |
433 |
($90.97) |
($90.97) |
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1119 |
09/26/2014 |
Traffic Systems & |
433 |
($137.55) |
($137.55) |
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Services |
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1120 |
10/08/2014 |
Duquesne Light |
433 |
($1,720.30) |
($1,720.30) |
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1121 |
10/28/2014 |
Traffic Systems & |
433 |
($293.34) |
($293.34) |
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Services |
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1122 |
11/07/2014 |
Traffic Systems & |
433 |
($867.14) |
($867.14) |
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Services |
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1123 |
11/07/2014 |
Modem service traffic |
433 |
($60.31) |
($60.31) |
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signal |
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1124 |
12/05/2014 |
Duquesne Light |
433 |
($7,775.07) |
($860.15) |
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1124 |
12/05/2014 |
Duquesne Light |
434 |
($7,775.07) |
($6,914.92) |
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1125 |
12/05/2014 |
Traffic Systems & |
433 |
($1,788.00) |
($1,788.00) |
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Services |
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1126 |
12/11/2014 |
Duquesne Light |
433 |
($813.61) |
($813.61) |
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1127 |
12/22/2014 |
Duquesne Light |
434 |
($13,663.07) |
($13,663.07) |
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1128 |
12/22/2014 |
Traffic Systems & |
433 |
($550.00) |
($550.00) |
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Services |
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1129 |
12/31/2014 |
Traffic Systems & |
433 |
($257.44) |
($257.44) |
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Services |
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TOTAL |
($143,803.74) |
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