SAMPLE CHART LISTING SETTLEMENT AMOUNTS

(We made a spreadsheet of all expenses.  Since they supposedly pay property damage separately then you could do one chart with property damage expenses only and one with medical.)

 

 
TOTAL EXPENSES
      Updated 6/16/05          
MILEAGE EXPENSES
DATE ACCT # PLACE ADDRESS PHONE ONE-WAY MILEAGE NOTES
                   
                   
                   
                   
                   
                   
  TOTAL ONE-WAY MEDICAL MILES      
Per the Internal Revenue Service:  "The standard mileage rate for moving or medical reasons was 14 cents per mile for 2004." DOUBLE ONE-WAY MILES FOR ROUND TRIP MILES   TIMES 14¢  
TOTAL MILEAGE EXPENSES $0.00
  POSTAGE AND ENVELOPES  
DATE TO ENVELOPES POSTAGE REASON  
           
           
           
           
TOTAL ENVELOPE EXPENSES $0.00            
TOTAL POSTAGE EXPENSES $0.00            
  TOTAL POSTAGE & ENVELOPE EXPENSES $0.00  
                   
MEDICAL EXPENSES
DATE ACCT # PLACE ADDRESS PHONE AMOUNT DATE PD NOTES
                     
                     
                     
                     
      TOTAL MEDICAL EXPENSES $0.00  
                     
                   
  PROPERTY DAMAGE EXPENSES   COPIES
DATE ITEM AMOUNT   DATE QTY AT $.10 EACH
               
               
               
               
               
  TOTAL PROPERTY DAMAGE EXPENSES $0.00