1. (a) The following is an illustration of Page 1 of Form 3:

   1. (1) List depositories alphabetically. Use a separate line for each deposit.
   2. (2) Give the account number, if any, assigned to the inactive deposit by the depository.
   3. (3) Give the balance as it appears on the treasurer's records.
   4. (4) Give the balance that must be secured in accordance with law.

   TO: Administrator of Local Agency Security

   111 Pine Street, Suite 1100

   San Francisco, CA 94111-5613

   FROM: ______________________________(Name of Treasurer)

   ______________________________(Title of Treasurer)

   ______________________________(Name of Local Agency)

   SUBJECT: Report of Inactive Deposits

   The following Report of Inactive Deposits is submitted in accordance with Article 5, Subchapter 4 of the Local Agency Deposit Security Regulations.

   Dated: ______________________________

   ______________________________(Signature)

   ______________________________(Name and Title)

   REPORT OF INACTIVE DEPOSITS OF __________(Name of Local Agency) AS OF ___(Date)

   (1)

   (2)

   (3)

   (4)

   Name of Depository and Location of Office

   Account No.

   Treasurer's Balance

   Secured Balance

2. (b) The following is an illustration of the continuation page of Form 3:

   1. (1) List depositories alphabetically. Use a separate line for each deposit.
   2. (2) Give the account number, if any, assigned to the inactive deposit by the depository.
   3. (3) Give the balance as it appears on the treasurer's records.
   4. (4) Give the balance that must be secured in accordance with law.

   Continuation Form ______________________________

   (1)

   (2)

   (3)

   (4)

   Name of Depository and Location of Office

   Account No.

   Treasurer's Balance

   Secured Balance

Note: Authority cited: Section 53661, Government Code. Reference: Section 53661, Government Code.

History

1. Amendment of subsection (a) filed 11-10-71 as procedural and organizational; designated effective 11-22-71 (Register 71, No. 46).

2. Amendment of subsection (a) filed 7-22-75 as procedural and organizational; designated effective 7-23-75 (Register 75, No. 30).

3. Amendment filed 10-8-76 as an emergency; effective upon filing (Register 76, No. 41).

4. Certificate of Compliance filed 2-4-77 (Register 77, No. 6).

5. Repealer and new section filed 7-16-80; effective thirtieth day thereafter (Register 80, No. 29).

6. Amendment of subsection (a) address filed 4-7-97; operative 4-7-97 pursuant to Government Code section 11343.4(d) (Register 97, No. 15).