HomeMy WebLinkAboutExp-05.2011-HellmannCity Council Member Statement of Expenses or Lost Income
Council Member's Dame: 6,tkNPN
For the month of ✓�f , 20 ! ,1 hereby certify that 1 have the
following expenses and/or lost income related to exercising my duties as a Council member.
W.1
(1. EXPENSES: v X
Please fill out sections a - d below and check taxable or non-taxable. m
z
(a.) Phone expenses: $ El El
(b.) ?, miles at I.R.S. rate: $. 55 $ 4(47 • e; 12 ❑ ®**
(c.) Home office expense for area set aside for City business: $ , d® ❑x
(d.) Other expenses - Please itemize below:
$ 0 El
$ ❑ 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 ! _ ® $ 0
111. TOTAL REIMBURSEMENT $ Zi
In no case can the amount of reimbursement exceed $800 per month.
Signed on the day of 20 81
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