HomeMy WebLinkAboutExp-10.2011-HellmannCouncil 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.