HomeMy WebLinkAboutExp-08.2011-SattlerCity of Georgetown
City Council Member Statement of Expenses or Lost Income
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Council Member's (Name:
For the month of
C"r ` e , 20 t I , I hereby certify that I have the
following expenses and/or lost income related to exercising my duties as a Council member.
EXPENSES:
Please fill out sections a - d below and check taxable or non-taxable.
(a.) Phone expenses:
(b.) 574 Z. miles at I.R.S. rate:$.SYper mile -A`''
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v x
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X �
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F— Z
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$ Fq El
$ 7.6 1 2. El
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(c.) Home office expense for area set aside for City business: $ = Z Ex I
(d.) Other expenses - Please itemize below:
61
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"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 $
El 0
0 El
El El
III. TOTAL REIMBURSEMENT
In no case can the amount of reimbursement exceed $800 per month. t, .L
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Signed on the day of S._ Pt �r t20 I ((
signature
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City of Georgetown
City Council
a i^ ,ice Reimbursement Forl
Council Member's Name: Z, <- �� 7-77
For the month of:
�&j5�� a(
i'Date
Destination
-
I
- .-Business
Purpose for Travel
Ilr
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i,
otals: 0 $:2]
Signature:
Dater
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