For questions regarding this form, contact the Local Government Division hotline: (877) 304-3899
LOCAL GOVERNMENT DIVISION
CERTIFICATION OF 3/5 MAJORITY VOTE FORM
Name of Government: ______________________________________________________
Unit Code Number: ___ ___ ___ / ___ ___ ___ / ___ ___
Pursuant to 50 ILCS 310/3, I, _________________________________________, the official record keeper
of ______________________________________________________________________ government,
certify that a copy of the FY_________ Annual Financial Report containing information required by the
Comptroller, has been provided to each member of the governmental unit's board of elected officials,
presented either in person or by a live phone or web connection during a public meeting, and was approved
by a 3/5 majority vote.
__________________________________
Official Record Keeper Signature
__________________________________
Title
__________________________________
Date
__________________________________
Phone
(affix government or notary seal/stamp here)
____________________________________
Notary Signature
ALL FIELDS MUST BE PROPERLY COMPLETED TO BE AN APPROVED DOCUMENT
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