CITY COUNCIL DISCRETIONARY FUNDS
REQUEST FOR EXPENDITURE
Acc
ount Number: ___________________
Submission Date: ___________________
Cur
rent Council Policy Manual Chapter 5.10 Acknowledgement Form on File? Ty
pe of Expenditure:
Select the category of authorized expenditure from Council Policy Chapter 5.10 and attach the corresponding documentation for the selected expenditure.
CP
M 5.10.010(4)(A) CPM 5.10.010(4)(B)
Community Application Travel Reimbursement
CP
M 5.10.010(4)(C) CPM 5.10.010(4)(D)
Membership Reimbursement Sponsorship Event
Brief Description: _____________________________________________________________________ Date for Expenditure: ____________________
Amount for Expenditure: _________________
Expenditure Payable to: _________________________________________________________ I
certify that the information and materials submitted are true to the best of my knowledge and belief. I understand that I subject myself to potential enforcement action under Council Policy Chapter 5.10 if the submitted information is found to be falsified or out of compliance with the policy.
Co
uncilmember Name: _________________________________________________________ Co
uncilmember Signature: ______________________________________________________ Appr
oval Signatures:
Ci
ty Attorney’s Office:
Received Date: ___________ Approval Date: ___________ Signature: ________________________ Ci
ty Manager’s Office:
Received Date: ___________ Approval Date: ___________ Signature: ________________________
ATTACHMENT F
CPM 5.10.010(4)(A), COMMUNITY APPLICATION
Community Application Attached.
W-9 Attached.
Applicant signed Acknowledgement Form Attached.
Expenditure is not political in nature _____ (Initial)
Expenditure is not religious in nature _____ (Initial)
Expenditure has no P ersonal Benefit _____ (Initial)
CPM 5.10.010(4)(B), TRA VEL REIMBURSEMENT
Name of Organization, Conference, or Event: ___________________________________ Purpose of Travel:
Communication or meeting with constituents.
If selected, identify constituents: ______________________________________ Attend local events that have a Community Benefit.
If selected, describe Community Benefit and attach supporting documentation:
_________________________________________________________________ _________________________________________________________________ Attend City-sponsored events.
If selected, identify City-sponsored: ____________________________________ Date of the Event: ___________________ Location of the Event: ________________________ Expenditure is not political in nature _____ (Initial)
Expenditure is not religious in nature _____ (Initial)
Expenditure has no P ersonal Benefit _____ (Initial)
CPM 5.10.010(4)(C), MEMBERSHIP REIMBURSEMENT
Name of Organization: _____________________________________________________ Description of Community Benefit: _________________________________________________ ______________________________________________________________________________ Documentation Supporting Community Benefit Attached.
Expenditure is not political in nature _____ (Initial)
Expenditure is not religious in nature _____ (Initial)
Expenditure has no P ersonal Benefit _____ (Initial)
CPM 5.10.010(4)(D), SPONSORSHIP EVENT
Description of Event: ____________________________________________________________ Description of Community Benefit: _________________________________________________ ______________________________________________________________________________ Documentation Supporting Community Benefit Attached.
List of Additional Participants, if any: _________________________________________ Expenditure is not political in nature _____ (Initial)
Expenditure is not religious in nature _____ (Initial)
Expenditure has no P ersonal Benefit _____ (Initial)
ATTACHMENT F