HomeMy WebLinkAboutExp-02.2012-MeigsCite 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