N.J. Admin. Code § Tit. 5, ch. 30, app APPENDIX
SPECIAL CONFIDENTIAL REPORT--SECTION 1, PAGE 1
(Preliminary report to be filed within forty-eight hours after discovery)
NOTE: File one copy with the Division of Local Government Services, and where a shortage develops, one copy with the municipality, county, or regional services agency.
LOCAL UNIT: ______________________
MUNI CODE: ________
COUNTY: __________________________
1. OFFICIAL
(a) Name and Title
(b) Length of service
(c) Name of other person working in or having access to the same
(d) Duties of persons referred to in (c)
2. AMOUNT INVOLVED $__________________
(If amount involved is not definitely known, so state, but give known amounts and facts as determined to date-render supplemental reports of findings from time to time, and give final report in Section 2.)
3. DISCOVERY
(a) Date
(b) Facts and circumstances leading to discovery
(attention is directed to the text of the "Requirements of Audit")
SPECIAL CONFIDENTIAL REPORT-SECTION 1, PAGE 2
LOCAL UNIT: ______________________
MUNI CODE: ________
COUNTY: __________________________
4. SURETY BONDS
Corporate
(a) Amounts and Company __________________________________
(b) New bond each year Yes ____ No ____
(c) Continuation certificate Yes ____No ____
(d) Name, address, and business of each bondsman
(e) Amount
5. REPORTED TO
(a) Governing Body
(1) How--written or oral
(2) Date
(b) Bonding Company
(1) By whom
(2) Company Direct
(3) Agent of Company
(4) How
(5) Date
(c) Prosecutor
(1) By whom
(2) How
(3) Date
Date ____________20____Signed
Print Name: ___________________
Registered Municipal Accountant
SPECIAL CONFIDENTIAL REPORT--SECTION 2, PAGE 3
(To be filed upon completion, or reasonable determination of amount)
LOCAL UNIT:______________________
MUNI CODE: ________
COUNTY: __________________________
6. METHOD OR METHODS USED BY OFFICIAL
(a) In obtaining funds
(b) In covering up shortage
7. AMOUNT OF SHORTAGE AS DETERMINED AT THIS DATE, AND DATE OF
DETERMINATION___________
8. REPORT OR REPORTS TO
(a) Governing Body
(1) How--written or oral
(2) Date
(b) Bonding Company
(1) By whom
(2) To Whom
(3) How reported
(4) Date
(c) Prosecutor
(1) By whom
(2) How
(3) Date
Date ____________20____ Signed
Print Name: ___________________
Registered Municipal Accountant
SPECIAL CONFIDENTIAL REPORT--SECTION 3, PAGE 4
(To be filed upon disposition of case)
LOCAL UNIT: ______________________
MUNI CODE: ________
COUNTY: __________________________
9. DISPOSITION OF SHORTAGE OF ______________________
(a) Repayment by
(b) Terms of Bonding Company Settlement
10. REMARKS
(Note: Legal or criminal action and results)
Date ____________20____ Signed
Print Name: ___________________
Registered Municipal Accountant
Note: To Registered Municipal Accountant
No report will be considered complete
Until all three (3) sections are filed
N.J. Admin. Code Tit. 5, ch. 30, app APPENDIX