HomeMy WebLinkAboutExp-07.2011-HellmannCity of Georgetown
City Council Member Statement of Expenses or Lost Income
Council Member's Name: G/✓�A Ij�
For the month of
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20 � ( , I hereby certify that I have the
following expenses and/or lost income related to exercising my duties as a Council member.
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I. EXPENSES: aj X
Please fill out sections a - d below and check taxable or non-taxable. 7
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(a.) Phone expenses: $ ❑**
(b.) miles at L-R.S. rate: $.50 per mile $ a **
(c.) Home office expense for area set aside for City business. $ C 0
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(d.) Other expenses - Please itemize below.
$ D D**
$ 0 0**
$ 0 0**
**These items can be reimbursed non-taxable per IRS guidelines when detailed receipts or mileage
reports are attached to this form.
II. LOST INCOME
(e.) Hourly rate X hours spent =Lost Income
� x Z 2 = sees
111. TOTAL REIMBURSEMENT
In no case can the amount of reimbursement exceed $800 per month.
Signed on the ZZvA day of
signatu
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