HomeMy WebLinkAboutExp-11.2011-Sattleryews r
Council Member's )Name:
For the month of 20 , 1 hereby certify that I have the
following expenses and/or lost income related to exercising my duties as a Council member.
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1. EXPENSES;
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Please fill out sections a - d below and check taxable or non-taxable,
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(a.) Phone expenses:
(b.) ( F miles at i.R.S, rate: $.555 per mile
(c.) Home office expense for area set aside for City business:
(d.) Other expenses - Please itemize below:
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"These items can be reimbursed non-taxable per IRS guidelines when detailed recuts or mileage
reports are attached to this form.
11, LOST INCOME
(e.) Hourly rate X hours spent = Lost income
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111. TOTAL REIMBURSEMENT $
1n no case cora the amount of reimbursement exceed $100 per month.
Signed on the ( day of_ 20
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