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ti�� <br />Application �'or Exemption frorr� Audit � <br />Eor the year ended December 31, �n�3 <br />(Fiscal year ended) � � _ � , � � <br />Entity: '__Town� of ui � � r�ce '', ` <br />Address: 315B Emerson St ., P 0 Box 1 <br />Hillrose, CO 80733-0001 <br />'I'ele��i�oue: ( 970 ) 847-3761 Year Last Audited: 1993 <br />r�, , . , . , <br />T'he Local Goyer�ment Audit� Law, Section 29-1-604, C.R.S., re uires local governments to meet the <br />following criteria in order to be considered for'approval for exemption from audit requirei�ients by the <br />Officc of thc State Auditor. <br />Revenues ur F,xpenditures Exempt from Audit? Who completes exemption form7 <br />Less than $100,000 Yes *�erson skilled in governmental <br />accounting <br />More than $100,000 but less Yes **Independent accountant �vith <br />than $300,000 knowledge of govenlmental <br />accounting requireme�Its <br />More tlian $300,000 No Not Applicable <br />(Audit is required) <br />* 'I'his meaus unscrccino cufnrlo..r �,.,..:.,��a,... ..c _--.----_- <br />� <br />"'�ndependent means somcone who ls separate �rom the entity "VU111°K �u cumpie�e �ne exemptwn torm. <br />Certification of Preparer <br />1 certify that I meet the requirements above to complete this Application for Exemption fi Audit and that <br />the information in this Application is complete and accurate to the best of my kno�vledge. <br />Name: Joanne Gosselink Title: Accountant <br />Firm Name: <br />Firm Address: 29382 Co. Rd. R Brush CO 80723 <br />Date Prepared: 4/5/04 Phone Number: ( 970 ) 842-0669 <br />.. _ <br />SIGNATURE: <br />The Audit La�v requires that a person independent of the entity complete the Application if revenues <br />or expenditures are more than $100,000 but less than $300,000. Please describe what your <br />relationship is with the entity. <br />Independent Accountant <br />Application for Exemption from Audit - Revised 10/03 • Signatures 1 <br />