Laserfiche WebLink
EXHIBIT B <br />INDIAN RIVER COUNTY <br />CHILDREN'S SERVICES ADVISORY COMMITTEE <br />REIMBURSEMENT REQUEST — 2024/25 REQUEST # <br />Agency <br />Program <br />Address <br />Phone <br />Email <br />Fax <br />Grant Award Amount <br />Remaining Award I Current Reimbursement <br />............ <br />Payment Total <br />Date Payee/Vendor Expense Explanation I Expense Type Proof of Payment" <br />(e.g., salary, benefits, supplies) e. ., invoice, a stub) <br />TOTAL <br />'Expenses must include itemized original invoice and receipt or canceled check as proof of payment. <br />'Salaries must show a breakdown the hours paid by type (e.g., regular, sick, vacation). Please note the County will NOT <br />Reimburse for SICK or VACATION time so those must be deducted from the request prior to submitting <br />1 hereby certify that the above costs are true and valid costs, incurred in accordance with the program funding <br />agreement. t further attest that the above costs were not. nor will be. reimbursed through other funding sources. <br />Name and Title Signature Date <br />