Dissolution of Public and Association Libraries in New York State


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The University of the State of New York
The State Education Department
New York State Library / Division of Library Development
10B41 Cultural Education Center
Albany, NY 12230

We, the trustees of _______________________________ , have received from the board of trustees of _____________________ the books and other
library property described in the following inventory and transferred by them to us by vote of __________dated _________ 20___ for the free use of the inhabitants of (specify locality to be served) _____________________________.

Having received the approval of the Regents under seal we give this receipt in accordance with Education Law, by which the entire responsibility for the said property is transferred and hereby accepted. Signature Board President: ____________________________________

Sign two copies (Board President) send one to The New York State Library, Division of Library Development, Cultural Education Center, Room 10B41, Albany, NY 12230. Attach the other to the Regents' approval and file with the board making the transfer as evidence of full relief from further responsibility for the project.


Library Collection

Number of Items

Estimated Value
(replacement value)

1) Print Materials   $
2) Electronic Materials   $
3) All other non-book - physical items   $
4) TOTAL Library Collection (add lines 1-3)   $
Other Property & Assets Estimated Value
5) Building and Grounds (indicate one)  
 Own |  Rent $
6) Library furniture and equipment $
7) All other assets not included in #5 and #6 above (real estate, investments, stocks, bonds, mortgages, etc.) $
8) Accounts receivable total $
9) TOTAL Other Property & Assets (add lines 5-8)  
Cash on hand and in bank including Capital Fund  
10) Cash $
11) Capital Fund $
12) TOTAL Cash on hand and in bank and Capital Fund (add lines 10-11) $
GRAND TOTAL (add lines 4, 9, and 12)  
In witness whereof, we have made, signed and acknowledged this plan of dissolution, on this __________ day of __________, 20___.

(Signature of trustees)

COUNTY OF       )

On this __________ day of __________, 20___ before me personally came the ____ (insert number of trustees whose signatures appear above), to me known to be the persons described in and who executed the foregoing application, and severally duly acknowledged to me that they executed the same.

(Typed name, stamp and signature of notary public)

Last Updated: August 31, 2009