Name: ______________________________SSN: ______________________  Tax Year:
____________

Name of Organization:
_________________________________________________________________

Description of Services performed:
_______________________________________________________
Dates of Services performed :
___________________________________________________________

DEDUCTIBLE EXPENSES

 AUTO EXPENSE OR MILAGE
   Ending Odometer reading:            __________
   Less Begining Odometer reading: __________
   Total Miles Driven:                      _________        Times ___ cents       = $ ________

 TRAVEL EXPENSE:
   List Air, Rail, Bus, Taxi, or other means of travel:
    ________________________________________
    _________________________________________     Total Travel     = $ ________

 LODGING EXPENSE:
   List Motel and other lodging expense:
    _________________________________________
    _________________________________________      Total Lodging  = $ ________

 MEAL (FOOD AND BEVERAGE) EXPENSE:
    List actual costs of bood and beberage expenses. (Not per-diem)
    ________________________________________
    ________________________________________ Total Meals 100%  = $ ________

    Total out of pocket expenses:                                                            $  _________
    Less any reimbursement received                                                      $  (_________)
    Total Charitable Expense Deduction to Schedule A                              $   _________

   Attach receipts to the back of this page to verify expenses listed.
CONTRIBUTIONS OF EXPENSES OF VOLUNTARY SERVICES
VOLUNTARY SERVICES as a Charitable contribution must be performed for a qualified
organizatio as defined. Such gratuitous activities may be in connection with charitable non-profit
organizations. The services must actually be rendered entirely for the benefit of the qualified
organization and do not include activities merely of a sef-participation nature.
The out of pocket expenses that you pay in rendering services without compensation to a non-profit
organization are the amounts that are deductible as contributions. Receipts, or a diary, are required.
These include amounts you pay for transportation from your home to and from the place where you
serve, and in transportation of persons, supplies and equipment for eligible activities. You may
deduct unreimbursed expenditures for gas and oil in the operation of your car (but not any part of
general repair and maintenance expenses). Or you may use a standard millage rate of 14 cents a
mile to determine your contribution. In either case, parking fees and tolls are deductible, but not
depreciation and insurance.
Away from home expenses (travel) are not deductible if there is any significant element of personal   
  pleasure, recreation or vacation in such travel.
100% of unreimbursed meals while away from home over night donating services is generally         
deductible.
Cost and upkeep of uniforms that have no general utility, and are required, are deductible.
The value of time or services contributed is not deductible, only the actual out-of-pocket expenses
paid.

Information provice by
Oregon Tax Services, LTD. Please be advised to consult with your own
income tax consultant concerning any tax deduction.  
email: oregontaxservice@aol.com

IRS Website IRS.gov
IRS Publication 526 Chartiable Contributions
IRS Publication 561 Determining the Value of
Donated Property