Airport Name: Insert airport name.

Location ID: Indicate the FAA location identifier, which is a 3- to 4-digit alphanumeric code.

Fiscal Year End: Insert the ending date of the fiscal year for which the information is provided.

Payments to Other Government Units: Airports often make payments to the city, county, state, branches of the federal government, and other political subdivisions. Enter payments for services, fees, reimbursements, equipment charges, utilities, bond payments, grandfathered payments, and the other payments indicated on the form. Do not include payments of less than $1,000 or payments for payroll tax, workers compensation, employee benefits, FICA, or employee retirement accounts. Please complete a separate form for each unit of government. For instance, complete a separate form for payments the airport made to the city, to the county, to the state, and to branches of the federal government. If the airport did not make payments to any governmental units during the fiscal year, the airport must write “NONE” in the first box of this section.

Name of government entity. Insert the name of the government entity to which the airport made payments. Use a separate form for each government entity.

Type of payment. Please complete the appropriate lines.

Amount. Enter the amount of the payment.

Example 1. City A owns and operates ABC International Airport. ABC International Airport uses vehicles from the City A’s motor pool to support airport operations. The City’s Department of Transportation runs the motor pool. This fiscal year, the airport’s cost of the motor pool service totaled $50,000, and the airport paid $50,000 for those services. Based on this information, the ABC International Airport would report that it made a payment of $50,000 to City A for fleet services.

Example 2. County B owns and operates CBA Regional Airport. CBA Regional Airport, however, does not have its own engineering or legal staff, so the County B Engineering Department handles the airport’s engineering and the County B Legal Department handles the airport’s legal work. County B charges CBA Regional Airport for the engineering and legal services through an indirect cost allocation plan. For this fiscal year, County B allocated $75,000 to the airport. Of this amount, $25,000 was for engineering and $50,000 was for legal services. Based on this information, the CBA Regional Airport would pay the $75,000 and report that it made a payment to engineering

for $25,000 and a payment to legal services for $50,000. If either payment were less than $1,000, the airport would not report it.

Property and/or Services Provided to Other Governmental Units: Airports often provide property and/or services to other units of government for a variety of reasons or purposes. For example, an airport provides the parks department land for a golf course, or it may provide aeronautical facilities to a sheriff’s search and rescue unit. Services provided to other units of government may include services provided by employees of the airport, such as ground maintenance for a parks department, right of way for county roads, or easements for electrical power metered through the airport. Please complete a separate form for each unit of government. For instance, complete a separate form for property and/or services the airport made to the city, to the county, to the state, and to branches of the federal government. If the airport did not provide property and/or services to any government units during the fiscal year, the airport must write “NONE” in the first box of this section. Each form should be filled out, as follows:

Property and/or services provided. List all property and/or services provided to a unit of government, such as a city, county, or state agency. Do not include land provided to the FAA for NAVAIDs and other air traffic control equipment or land and airport facilities that the airport provides to other government units to be used exclusively for operational requirements of the airport. If the sponsor did not provide property and/or services to other government units during the fiscal year, the airport must write “NONE” in the first box of this section.

Name of government entity. Insert the name of the government entity (i.e., city, county, state, or branch of the federal government) to which the airport provided property and/or services. Use a separate box for each government entity. Use additional copies of the form as needed to report payments to other government entities.

Department. Insert the governmental department or agency that received the property and/or service from the airport (e.g., parks and recreation department or public works department). Report each property and/or service provided to the same agency or department separately, repeating the agency or department name in the “Department” column for each property and/or service provided.

Use. Enter whether the service or use was aeronautical or nonaeronautical by inserting an “A” or “N” in the box.

Type. Enter whether the airport received fair market value, less than fair market value, or nominal value for the service or property that the airport provided by entering “FMV,” “L,” or “N” in the box.

Fair market value. Enter the fair market value of the service or property provided.

Value of in-kind services. If the unit of government paid for the service or property with in-kind services, enter the value of the services provided and attach a schedule that describes the service.

Cash compensation. Enter the cash compensation that the unit of government paid for the service or property provided.

Example 1: City A is the owner and operator of the ABC International Airport. The ABC International Airport allows the Parks and Recreation Department of City A to use six acres of airport property for little league baseball fields. City A pays the airport $1 a year for the use of land. A parcel of land adjacent to the baseball fields is leased to an aeronautical user of the airport for $1,000 per acre, making the estimated value of the land used by the Parks and Recreation Department $6,000. Based on this information, the ABC International Airport would report the following: City A, Parks and Recreation, “Use as Baseball Fields,” “N,” “N,” $6,000, None, $1. (Nonaeronautical use; received nominal value; fair market value is $6,000; no in-kind services provided; $1 actual cash received.)

Example 2: City A owns ABC International Airport and County B owns a park adjacent to the airport. The city and county entered into a contract where the city agreed to provide the park’s mowing and snowplowing for the county for $30,000. The city deposited the $30,000 into the airport’s fund. The airport’s cost of providing these services was $26,000. Based on this information, the airport would report the following: County B, Department of Parks, “Mowing and Snowplowing,” “N,” “FMV,” $26,000, None, $30,000. (Nonaeronautical use; received fair market value; fair market value is $26,000; no in-kind service provided; $30,000 actual cash received.)