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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. I further attest that the above costs were not, nor will be, reimbursed through other funding sources. <br />Name and Title <br />Signature Date <br />129 <br />