Affidavit and Revenue Certification (S)

_Zachary Taylor Parkway Commission ENTITY NAME

^West Feliciana Parish

_St. Francisvllle. LA ^(City), State

ANNUAL SWORN FINANCIAL STATEMENTS AND CERTIFlCATiON OF REVENUES $75,000 OR LESS (If applicable)

The annual swom financial statements are required by Louisiana Revised Statute 24:514 to be filed with the Legislative Auditor within 90 days after the dose of the fiscat year The certification of revenues of $75,000 or less, if appilcabte, is required by Louisiana Revised Statute 24:513(J)(1)(c)(i)(aa).

Personally came and appeared before the undersigned authority, _J. Curtis Jetks. (enter officer name), who, duly swom. deposes and says that the financial statements herewith given present fairly the financial position of _Zachary Taylor Parkway Commission ^(enter entity name) as of 30 June 2017 (entity's year-end), and the results of operations for the year then ended,

in accordance with the basis of accounting de^bed within the accompanying financial statements.

^ (officer name), who, duly swom, deposes and says that (Complete tf applicable) In addition, _J. Curtis Jelks _Zachary Taylor Parkway Commission (entity name) received $75,000 or less in revenues and other sources for the year ended 30 June 2017 , and accordingly, is not required to have an audit for the previously mentioned year.

fficer's Signature

Swom to and subscribed before me this / ̂ day of 20/

NOTARY PUBLIC SIG &SEAL

STEWART B. HUGHES NOTARY PUBLIC NOTARY « 9088>

STATE OF LOUISIANA My Commission is For Lire.

For Office Use Only Undtr pro^rfstons or ttste law. Stit report wta become a pubRe docunwnt on ttw Monday fbOoM^ the relesee date. A eopy of ttte report wOI be cvbmfttsd to approprtata pubOc officials and be avaDabte for public fospedion at the Baton Roupa offioe of the Louisiana Legbiatlva Autftor and, where apprepitote. at the onea o( tha parish derft oT <

FWaaaaOata. 'HCT 2 5 2017

Ptease Complete This Section _J. Curtis Jelks Chairman

Officer's Name Officer's Title __ Address _13622 James Lane City, Zip.Norwood, 70761 ] Ph: Cell/Land_225-719-2715 E-mail Jqelks@hughes.net

Please retgrp the wmplcted form within 90 days of vour entity's vear^end to Louisiana Legislative Auditor - Local Government Services: Post Office Box 94397. Baton Rouoe. LA 70804-9397 - UBd.i«i OTTIS

statement A Pages

zachwv Tdvigr PsrlwsY comn»i«f (Agency Name)

Statement of Cash Receipts and Disbursements For the Year Ended 30 June 2017 (Year-End)

General Other Fund Fund Total

RECEIPTS (Provide Brief Description): 1. CD6G Grant Income s $22,672.91 $22,672.91 2. 3. 4. 5. 6. Total receipts (add lines 1 - 5) $ $22,672.91

DISBURSEMENTS (Provide Brief Description): 7. ZTP Association - CDBG Grant Management $ $22,672.91 $22,672.91 8. 9. 10. 11. 12. 13. Total Disbursements (add Ones 7-12) $ $22,672.91

14. Change in lund balance (Unes 6 minus 13) $ $ $0 15. Fund Balance at beginning of year $ $ $8,616.14 16. Fund balance (deficit) at end of year (Add lines 14-15)

-This amount also aces on One 12. Statement B $ $ $8,616.14

PLEASE RETAIN A COPY OF THE COMPLETED FINANCIAL STATEMENTS FOR YOUR RECORDS

Please return the comply form wfthin 90 davs of vour entltv-s vear-end to Loulalana LealateBve AudWor - Local Baton Rouge. LA 70804-0397 - ui.d«.d aanB

Statement B Page 4

Zacharv Tavfor Parkway Commission (Agency Name)

Balance Sheet, on 30 June 2017 (Year-End)

General Other Fund Fund Total

ASSETS (balances at year-end) -Give brief description: 1. Cash and cash equivalents on hand 5 5 $8.6i6.i4 2. Investments (fair value) on hand 3. Office furnishings (Cost of desks, etc) 4, Equipment (Cost of fax machine, etc) 5. Other (brief description) 6. Total Assets (add lines 1 - 5) $ $ $8,6i6.i4

LIABILITIES AND FUND BALANCE (at year-end): 7. Liabilities (give brief description): 8. $ $ $0 9. 10. 11. Total Uablllties (add lines 7-10) 0 12. Fund balance (amount fipom Line 16 on Statement A) 8.616.14

13. Other 14. Total Liablllttes and Fund Balance (add lines 11-13) $ $ $8,616.14

PLEASE RETAIN A COPY OF THE COMPLETED FINANCIAL STATEMENTS FOR YOUR RECORDS

-Local Govemment Services: Post Office Box 94397. Baton Rouoe. LA 70804-S397 - undrtBdgo/iB

statement C Pages

Zacharv Tavtor Parkway Commission (Agency Name)

Schedule of Compensation, Benefits and Other Payments to Agency Head or Chief Executive Offlcer (Required Form - Please Submit Completed Form Per Attached Instructions)

For the Year Ended 30 June 2017 .(Year-End)

Agency Head Name and Title: N/A

Purpose Dollar Amount 1. Salary 1.

2. Benefits-Insurance X

3. Benefits-retirement 3.

4. Beneflt&^ther (describe) 4.

5. Benefits-other (describe) 5.

6. Benefits-other (describe) 6.

7. Car allowance 7. 8. Vehicle provided by government drraportKi on vour w-2) 8. 9. Per diem 9.

10. Reimbursements 10.

11. Travel 11.

12. Registration fees 1Z

13. ConfererKe travel 13.

14. Housing 14.

15. Unvouchered expenses (example; travel advances, etc.) 15.

16. Special meals ie 17. Other 17.

18. TOTAL (enter total of line 1-17) 18.

X Please check here rf the Agency Head does not receive any compensation, benefits, and other payments. (Act 462 of the 2015 Legislative Session allows nongovemmental entities or not-for-profit (quasi-public) entitles to report on the Act 706 schedule only those payments to the agency head that are derived from the public funds.)

NOTE: The Zachary Taylor Parkway Commission does not have any employees. The day-to-day operations are overseen through the Zachary Taylor Parkway Association.

PLEASE RETAIN A COPY OF THE COMPLETED FINANCIAL STATEMENTS FOR YOUR RECORDS Please return the compteted form within 90 davs of vour entity's vear-end to Louisiana Legislative Auditor - Local

Government Servloes: Post Office Box ^397. Baton Rouoe. LA 70804-9397 • uodnid