2 | P a g e M F O A p p l i c a t i o n v . 1
Please list all Cities and Villages which have already merged with a FPD:
____________________________ ____________________________ ___________________________
____________________________ ____________________________ ___________________________
____________________________ ____________________________ ___________________________
____________________________ ____________________________ ___________________________
Per Neb. Rev. Stat. § 35-1207 …any organization seeking funds pursuant to the mutual Finance
Assistance Act shall submit an application and any forms required by the State Treasurer.
**Not using the correct forms will result in a delay in processing your application.**
Please check that you included the following information.
_____ Per Neb. Rev. Stat. § 35-1204 Included is a new agreement which shall include: a) a
duration of at least three years; b) the entities participating in the MFO have levied the same
agreed-upon tax rate for one out of every three tax years; c) all members levy no more than such
agreed-upon tax rate for the remaining tax years.
_____ Per Neb. Rev. Stat. § 35-1204 State Treasurer’s MFO Calculation Spreadsheet
_____ Per Neb. Rev. Stat. § 35-1207 Distribution of Prior Year Funding
Contact Person: ________________________________________________________
Address: ________________________________________________________
City, State, Zip: ________________________________________________________
Phone #: ________________________________________________________
E-mail (required): ________________________________________________________
I certify that the entities participating in the MFO have followed State Statutes and have used
the application and forms that the Treasurer’s Office requires.
Signature: ________________________________________________________
Title: _____________________________ Date: _________________________
Applications must be received electronically at nst.tmstaff@nebraska.gov or postmarked
no later than July 1.
Nebraska State Treasurer’s Office
State Capitol, Suite 2005
PO Box 94788
Lincoln, NE 68509
