Form 26B-7/6/2011 COMMONWEALTH OF VIRGINIA RICHMOND, VIRGINIA 232 ATTN: CHIEF FINANCIAL OFFICER Annual Report of Self- Year Ended December 31, Employer # Pursuant to the provisions of Section 65.2-this report must be prepared upon a calendar year Commission by March 15th. SEE INSTRUCTIONS ON THE BACK. CLASSIFICATION OF OPERATIONS: (The blank spaces are to be used in reporting payroll not specifically classified below.) CLASS CODES Total payroll for Twelve Mos. Ending December 31, Trans portation of Pupils including repair of vehicles 7380 $ All professional and clerical employees 8868 All other than professional, clerical & transportation employees 9101 Other Classifications TOTAL Signed this day by Date Signature of Representative and Title of Name and Address of School Board Fed. Tax ID# This day personally appeared before me, acknowledged their signature, and made oath that the foregoing report is correct. Given under my hand and seal this day of , . My commission expires SEAL American LegalNet, Inc. www.FormsWorkFlow.com Effective 1/1/1996 FORM 26B INSTRUCTIONS Type or print, on the form, all required information. Year ended December 31, - enter the calendar year being reported. Employer - enter the name of the school board. # - enter the 5-mailing label for number.) Classification of Operations - (Classification listings have been condensed. Please enter the total payroll for each classification code.) All salaries and wages paid or due officials and employees for the calendar year, together with other remuneration, if any, must be reported including amounts paid temporary and part-time employees despite the type of work done. Salaries and wages paid because of the operating of vacation and night schools must be included. The extra remuneration paid for overtime may be deducted; e.g., if time and a half is paid for overtime, the half may be deducted. Transportation of pupils - includes bus drivers, helpers and anyone involved in maintaining the vehicles. Professional and clerical employees - includes teachers, administrators, guidance counselors, librarians and their professional assistants, therapists, nurses and athletic coaches. Other than professional, clerical & transportation employees - includes employees engaged in the care, custody and maintenance of buildings, grounds and equipment, nonprofessional employees of libraries, and all non-clerical cafeteria employees. New construction work and alterations - done by employees of the School Board must be reported under the various construction classifications applicable such as masonry, plumbing, sheet metal work, etc. In reporting this payroll, if any, the blank spaces may be used for this purpose. Include a brief description of the type of work done. Enter the appropriate NCCI classification code for each type of work. Total Payroll for ... - Enter the calendar year being reported. (If reporting for a period other than a full calendar year please indicate on the form.) List the total payroll, on the corresponding line, for each classification reported. Total - Enter the total payroll for the school board operations. Notarization - dentification Number given. Please enter the name and telephone number of the person to contact if we have any questions regarding this report. Please print. Name of Contact Telephone Number American LegalNet, Inc. www.FormsWorkFlow.com