HomeMy WebLinkAboutExp-12.2011-HellmannCity of Georgetown
City Council Member Statement of Expenses or Lost Income
For the month of
20 1
1 hereby
certify that I have the
following •-and/orlost
incomerelated toexercising myduties•
member.
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
CU
tE
� X
cB
o
p- z
$ El 0
$ 0 0
(c.) Home office expense for area set aside for City business: $
(d.) Other expenses - Please itemize below:
$ 0
$ ❑ 0**
$ El
"These items can be reimbursed non-taxable per IRS guidelines when detailed receipts or mileage
are attached to this form.
11. LOST INCOME
(e.) Hourly rate X hours spent = Lost Income
X = 00 $ Ck2t 00 �.
III. TOTAL REIMBURSEMENT $ We
60
In no case can the amount of reimbursement exceed $800 per month.
SignedLft o •. %.
signature
City of Georgetown
CouncilCity b' Statement y^ or
w,
For • of 1, 1 I I hereby
following expenses and/or lost income related to exercising my duties as a Council member.
1. EXPENSES: (U X
Please fill out sections a - d below and check taxable or non-taxable.
� r
co C
CU o
t- z
(a.) Phone expenses: $ F1**
(b.} miles at I.R.S. rate: $.50 per mile $ El El
(c.) Nome office expense for area set aside for City business: $ F1
(d.) Other expenses - Please itemize below:
-- $ 0 El
$ 0 Q**
ese items can be reimbursed non-taxable per IRS guidelines when detailed receipts or mileage
its are attached to this form.
IL LOST INCOME
(e.) Hourly rate X hours spent = Lost Income
so X _ 10 0)00 $
Ill. TOTAL REIMBURSEMENT $
in no case can the amount of reimbursement exceed $800 per month.
Signed on the day of 20
signature
Council Member's Name: I
For the month of - (` , 20 1( , I hereby certify that I have the
following expenses and/or lost income related to exercising my duties as a Council member.
EXPENSES: X
Please fill out sections a - d below and check taxable or non-taxable.
X
~ Z
(a.) Phone expenses: $ El El
(b.) miles at I.R.S. rate: $.50 per mile $ ❑**
(c.) Home office expense for area set aside for City business: $ F1
(d.) Other expenses - Please itemize below:
$ 0 0**
P4
**These items can be reimbursed non-taxable per IRS guidelines when detailed receipts or mileage
are attached to this form.
0 0**
Ila LST INCOME
(e.) Hourly rate X hours spent = Lost Income
X = 100.00 $ too El
1
Ill. TOTAL REIMBURSEMENT $
In no case can the amount of reimbursement exceed $800 per month.
MIT 111, 1FIT, 0Mx..
t
)e
For the month of A Lt ��1,, 20 i , 1 hereby certify that I have 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:
miles at I.R.S. rate: $.555 per mile
(c.) Home office expense for area set aside for City business:
� nC,
$ El 0
ED El
�"These items can be reimbursed non-taxable per IRS guidelines when detailed receipts or mileage
reports are attached to this form.
IL LOST INCOME
(e.) Hourly rate X hours spent = Lost Income
X
r
A 1
III, TOTAL REIMBURSEMENT
In no case can the amount of reimbursement exceed $100 per month.
F iR1
Signed on the day of ` F. 20�.
F