Complete this once for the year. It gives your church board the figures it needs to adopt a designation, and it becomes the signed record we keep on file for you.
Use the church's full name. It tells us where this record belongs.
Use your full legal name, exactly as it appears on your pay records.
A designation only applies to pay dates after the board adopts it. It cannot be applied backward to pay you have already received, so choose a date the board can realistically meet.
Estimate the full year. Round figures are fine here. What matters is that you can back them up later with receipts and statements. The total becomes the amount you are asking the board to designate.
This is the total of your costs above. It fills in on its own, so there is nothing to enter here.
Every box has to be checked. They are the terms that make the designation work.
Your signature here has the same effect as signing on paper.