HomeMy WebLinkAboutExp-11.2011-HellmannCity of Georgetown
CouncilCity b' Statement y^ or
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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.
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(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