HomeMy WebLinkAboutExp-09.2011-HellmannCity of
Georgetown
Council Member's Name: �� ���Lirtn \A
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CITY OF GEORGETG-,,/�4
For the month of 120 1 , 1 hereby certify that I have the
following expenses and/or lost income related to exercising my duties as a Council member.
I1. EXPENSES:
Please fill out sections a - d below and check taxable or non-taxable.
(a.) Phone expenses:
(b.) miles at I.R.S. rate: $.50 per mile
(c.) Home office expense for area set aside for City business:
(d.) Other expenses - Please itemize below:
X
� x
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$ F1 ED
$ D 0
$ 1S0•m F
$ C El
$ E] D
$ _ E] El
"These items can be reimbursed non-taxable per IRS guidelines when detailed receipts or mileage
reports are attached to this form.
ll. LOST INCOME
(e.) Hourly rate X hours spent. Lost Income
IcX _
Ill. TOTAL REIMBURSEMENT
In no case can the amount of reimbursement exceed $800 per month.
Signed on the tt Z day of
signature
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