Detailed Capital Budget Form

CAPITAL BUDGET
FY2011 - FY2015
CAPITAL EXPENDITURE/ITEM REQUEST FORM
PLEASE PREPARE AND SUBMIT TWO (2) COPIES TO THE TOWN ADMINISTRATOR'S OFFICE
1.
2.
3.
4.
5.
6.
7. Cost:
8.
How will expenditure be funded?
9.
10.
Will the expenditure produce new revenue?
11.
If yes, please identify how and how much revenue:
12. What will be the additional annual operating cost?
13.
Will this expenditure remove property from the tax list?
If yes, please provide cost/benefit analysis:
14.
Please be sure to provide backup information.
Backup information attached
Division:
Department:
Fiscal Year:
Priority #:
Item/Expenditure:
Location:
Description of Project/Equipment/Item/Expenditure:
Need for Project/Equipment/Item/Expenditure:
Design of Plan
Estimated Completion/Receipt Date:
Estimated Start/Purchase Date:
TOTAL
Equipment
Inspection
Construction
Land Acquisition
Town Funds
State Funds Federal Funds
Please identify specific funds (Grants, Taxation, Rates, etc)
No
Yes
or will submit by:
1st Year
2nd Year
3rd Year
4th & Future Year
Why
Yes No
Submitted by:
Title:
Page 1/11
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