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CITY OF RAMSEY <br />EARNINGS DONATION POLICY & CONTRIBUTION FORM <br />Pursuant to Minnesota Statute, Section 465.03, employees, commissioners, and/or councilmembers <br />may elect to donate their payroll wages, in any value as determined by the employee, commissioner, <br />and/or councilmember, to the City of Ramsey. Any such donation will be made with after tax dollars and <br />be initiated independently from the payroll process. Form W-2 will be issued for the full amount of <br />wages paid for the calendar year. The City of Ramsey is not defined as a qualified charitable organization <br />as per the Internal Revenue Service; therefore, any such donations are not considered "charitable" for <br />tax purposes. <br />Cash donations may be made directly to the City of Ramsey by the employee, commissioner, and/or <br />councilmember in the form of a personal check or cash. Donations may be made at any time throughout <br />the calendar year. This form must accompany all donations. <br />Upon distribution of donations, the donor may elect to restrict the purpose of the payment by <br />designating a fund below. <br />CITY OF RAMSEY <br />EARNINGS DONATION CONTRIBUTION FORM <br />64kA v , hereby elect to donate $ 6 to the City of Ramsey to be <br />applied o the Fund ele 'e below. <br />Select one fund by placing a check mark on the appropriate line. <br />Safety Camp <br />Happy Days <br />Lawful Gambling * <br />Park Improvement Fund <br />General Fund <br />Other, Fund: <br />No preference, apply to the greatest need <br />*Expenditures must be associated with youth recreation, community, and athletic facilities and/or expenditures recommended by the Park and <br />Recreation Commission and authorized by the Finance Committee. <br />-.117V = vn _ u r- L1 <br />Full Name: <br />Address: <br />Phone: <br />Date <br />LAST UPDATED: June 11, 2012 <br />