Free 2008 SPL-01 Model Form - Wisconsin Legislators (fillable format) - Wisconsin

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2008 Model Form ­ Wisconsin Legislators
(For Making Internal Revenue Code Section 162(h) Election)

Name Address Residence within Legislative District

Social Security Number

For the tax year 2008 I have elected my district home as my tax home and I am now applying section 162(h) of the Internal Revenue Code which allows a per diem expense for living expenses attributable to my work as a state legislator for every legislative day. The number of miles between my residence within my legislative district and the capitol building is The number of my legislative days for tax year 2008 includes: Session days (including recesses of four consecutive days or less) Committee meeting days Total legislative days The per diem rate I am using is $143 for the period January 1, 2008, through September 30, 2008, and $144 for the period October 1, 2008 through December 31, 2008. These are the federal employee per diem rates which were in effect for Madison for 2008. My per diem expense is computed as follows: Legislative days at $143 per day = Legislative days at $144 per day = Total per diem expense Portion of per diem expense allocated to meals
(Total per diem expense x .3560) . . . . . . . . . . . . . . . . . . . . . .

.

Fill in here and include on line 5 of federal Form 2106 Fill in here and include on line 3 of federal Form 2106

Portion allocated to other living expenses
(Total per diem expense minus portion allocated to meals)

The total per diem reimbursement which I received from the State of Wisconsin for 2008 is . . . . . . . . . . . . . . . . . . Portion of per diem reimbursement allocated to meals (Total per diem reimbursement x .3560) . . . . . . . . . . . . . . . Portion of per diem reimbursement allocated to other living expenses
(Total per diem reimbursement minus portion allocated to meals) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

To line 7, Column B of federal Form 2106

To line 7, Column A of federal Form 2106

SPL-01 (R. 9-08)

Wisconsin Department of Revenue