HomeMy WebLinkAboutExp-02.2012-SattlerCity of ellW - _
City Council Member Statement 0f Expenses or Lost Inco le'
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Council Member's Dame: _ ' t e�,„
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For the month of 20 1 -1 hereby certify that F MWe'the _ ._. ...._.�
following expenses and/or lost income related to exercising my duties as a Council member.
1. EXPENSES:
Please fill out sections a - d below and check taxable or non-taxable.
(a.) Phone expenses:
(b.) - miles at I.R.S. rate: $.555 per mile
(c.) Nome office expense for area set aside for City business:
(d.) Other expenses - Please itemize below:
a,
X
x
X
X C
Ca o
$ C-1 ❑
$ 2e EFS
$ D El
$ _ Cl El
$ 0 0
"These items can be reimbursed non-taxable per IRS guidelines when detailed receipts or mileage
reports are attached to this form.
11, LOST INCOME
(e.) Hourly rate X hours spent = Lost Income
X = 0.00 $
M. TOTAL REIMBURSEMENT
In no case can the amount of reimbursement exceed $200 per month.
Signed on the _A day of 20
M 4. "rr
signature
Cite of Georgetown
City Council Member Statement of Expenses or L.ost I
Council Member's Name:
For the month of b 20 hereby certify
�.
following expenses and/or lost income related to exercising my duties as a Council member.
v
9e EXPENSES: a X
Please fill out sections a - d below and check taxable or non-taxable.
X
M 0
(a.) Phone expenses: $ 0 Ej**
(b.) miles at I.R.S. rate: $.555 per mile $ 0 0**
(c.) Home office expense for area set aside for City business: $ L_^__!
(d.) Other expenses - Please itemize below:
—_ $ _�**
$ El D
$_ EI El
**These items can be reimbursed non-taxable per IRS guidelines when detailed receipts or mileage
reports are attached to this form.
E€e LOST INCOME
(e.): ,Hourly rate X hours spent = Lost Income
rf
x_ .,,.`�t lam
BEI, TOTAL REIMBURSEMENT
In no case can the amount of reimbursement exceed $200 per month.
Signed on the - —^ —_ day of_ I z TE -t`
signature
20
5
f
�
For the month of b 20 hereby certify
�.
following expenses and/or lost income related to exercising my duties as a Council member.
v
9e EXPENSES: a X
Please fill out sections a - d below and check taxable or non-taxable.
X
M 0
(a.) Phone expenses: $ 0 Ej**
(b.) miles at I.R.S. rate: $.555 per mile $ 0 0**
(c.) Home office expense for area set aside for City business: $ L_^__!
(d.) Other expenses - Please itemize below:
—_ $ _�**
$ El D
$_ EI El
**These items can be reimbursed non-taxable per IRS guidelines when detailed receipts or mileage
reports are attached to this form.
E€e LOST INCOME
(e.): ,Hourly rate X hours spent = Lost Income
rf
x_ .,,.`�t lam
BEI, TOTAL REIMBURSEMENT
In no case can the amount of reimbursement exceed $200 per month.
Signed on the - —^ —_ day of_ I z TE -t`
signature
20
GeorgOf c
C.ity Council Member Statement of Expenses or I_os=_
�_.ouncil Member's Name:
r"`ry
For the month of .,r. 4T,"` ` 20 ' i_ , I hereby certify that ! have the
following expenses and/or lost income related to exercising my duties as a Council member.
le EXPENSES:
Please fill out sections a - d below and check taxable or non-taxable.
(a.) Phone expenses:
(b.) miles at I.R.S, rate: $$.555 per mile
(c.) Horne office expertise for area set aside for City business:
(d.) Other expenses - Please itemize below:
X
x
X
r—
X �
res O
F
$_ D Elx*
*'ihese items can be reimbursed non-taxable per IRS guidelines when detailed receipts or mileage
reports are attached to this form.
11. LOST INCOME
(e.) Hourly rate X hours spent = lost Income
X
0.00
El El
E D
F-1 Fx
S t X
I€i, TOTAL REIMBURSEMENT
In no case can the amount of reimbursement exceed $100 per month.
r A
qi ned on the I I
g day 20 ,
si