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Request for Stipend Payment Form

About the Stipend Program

  • Stipend amount is $50 per month, for months meetings were held, and where the member was present for the meeting.
  • Stipend payments will be issued according to the schedule determined by the City Clerk's office. At a minimum, payments will be issued twice annually.
  • Checks will be payable to the Member only.
  • The City will issue an IRS Form 1099  for stipend payments totaling more than $600 annually. Stipend payments may be taxable income. Please consult your tax professional for more information.
  • Recipients of the Stipend Program will be required to register as a payee of the City of San Rafael in the City's vendor system, in order to receive stipend payments. Please complete this W9 and email it to the City Clerk's office.
  • Members who receive a stipend will be required to complete a State of California Ethics Training prior to receiving payment. This free training is available at AB1234 Local Ethics Training through the Fair Political Practices Commission. Members will be required to complete Ethics Training every two years.

Instructions

  1. Complete the Request for Stipend Payment form below. This form will be electronically forwarded to the City Clerk's office.
  2. Alternately, you may print this form, and file it with the City Clerk's office.
  3. Recipients of the Stipend Program will be required to register as a payee of the City of San Rafael in the City's vendor system, in order to receive stipend payments. Please complete this W9 and email it to the City Clerk's office.
  4. The City Clerk will let you know if additional information is needed to process your stipend payment.
  • Type your full name
  • MM slash DD slash YYYY
  • What is the name of the board, commission or committee you serve on that you are requesting stipends for?
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