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  1. City Clerk
  2. Boards & Commissions
  3. Volunteer Stipend Pilot Program
  4. Request for Stipend Payment Form

Request for Stipend Payment Form

About the Stipend Pilot Program

  • Stipend amount is $50 per month, for months the Police Advisory and Accountability Committee (PAAC) held a meeting, 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 once 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.
  5. Only request payment for months that the meetings were attended. If you missed a meeting, please skip that month on the "Attendance" tracker below.
  6. 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
  • Part 2: Meeting Log
    • Please submit this form for meetings you have already attended in the previous year.
    • Please only list meetings that you attended for the Police Advisory and Accountability Committee. Do not enter scheduled meetings that you did not attend.
    • For questions or assistance, please contact the City Clerk's office by email.
    • Please select each month you attended the Police Advisory and Accountability Committee:
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