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I I � <br />� <br />APPLICATION FOR EXEMPTION FROM AUDIT - LONG FORM - FOR GOVERNMENTS WITH <br />REVENUES OR EXPENDITURES GREATER THAN $100,000 BUT NOT MORE THAN $500,000 <br />Return to: Office of the State Auditor <br />Local Government Audit Division <br />225 E. 16th Ave., Suite 555 <br />Denver, CO 80203 <br />Fax:(303)866-4062 <br />Email: OSA. LG@state.co. us <br />Call (303) 866-3338 if you need help completing this form. <br /> ��� <br />Section 29-1-604, C.R.S. outlines the provisions for an exemption from audit. Generally, any local government where <br />neither revenues nor expenditures exceed $500,000 in any fiscal year qualify for an exemption. <br />If either revenues or expenditures are $100,000 or greater, but not more than $500,000, you may use this <br />form. If both revenues and expenditures are less than $100,000 individually, use the short form application <br />for exemption from audit. <br />Instructions: (See "Instructions" tab for additional information) <br />1. Prepare this form completely and accurately. Pleae note that there are eleven parts to this form and all questions <br />must be answered for the application to be considered complete. <br />2. File this form with the Office of the State Auditor within 3 months after the end of the fiscal year. <br />For years ended December 31, the form must be received by the Office of the State Auditor by March 31. <br />3. The form must be completed by an independent accountant (separate from the entity) with knowledge of <br />governmental accounting. <br />4. The application must be approved by the governing body as evidenced by one of the following methods: <br />a. Resolution of the governing board - application may be e-mailed, faxed, or mailed. <br />b. Original signatures - application must be mailed. E-mail or fax will NOT be accepted. <br />5. The preparer must siqn the application that is submitted in order for it to be accepted. <br />6. Additional information mav be attached to the exemption at the preparer's discretion. ___ <br />� Page 1 <br />I The Audit Law requires that a person independent of the entity complete the Application if revenues or expenditure are at least I <br />$100,000 but not more than $500,000. Independent means someone who is separate from the entity. Please describe what your <br />relationship is with the entitv. <br />