YEAR-END REPORT NO. 22, STATEMENT OF CONTINGENT LIABILITIES - 7980
This report discloses estimated liabilities such as federal audit exceptions, other audit exceptions, and pending litigation. A Statement of Contingent Liabilities, Report No. 22, is not required if there are no contingent liabilities. In this situation, departments will indicate that there are no contingent liabilities to report in the certification letter to the SCO.
A sample of Report No. 22, Statement of Contingent Liabilities, is shown in the 7980 Illustration.
7980 Illustration
(Revised 03/02)
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Agency Name and Number Fund Name and Number STATEMENT OF CONTINGENT LIABILITIES – REPORT NO. 22 As of June 30, 20__
Prepared by: ____________________ Telephone number: _______________
Type of Contingent Liability Reference or Estimated Estimated Date Comments Identification Amount of Payment
e.g. Federal Audit Exception Federal Audit Dollar Amount By Fiscal Year
I certify (or declare) under penalty of perjury that the foregoing is true and correct and that I have not violated any of the provisions of Article 4, Chapter 1, Division 4, Title 1, Government Code (commencing with Section 1090).
Subscribed and executed this _____day of __________, 20__ at ________________, CALIFORNIA.
_______________________________ Signature of Officer
_______________________________ Type or print name of Officer
_______________________________ Title of Officer
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