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INDIAN RIVER COUNTY <br />CHILDREN'S SERVICES ADVISORY COMMITTE <br />REIMBURSEMENT REQUEST- FY25 26 <br />Ag,nncy Pw !t,Jrn <br />A.ditess Phcm <br />IC <br />Err ait �T <br />REOUEST I <br />=ayment <br />Date <br />Payee VenJor <br />r_; Period <br />Gross salar•; <br />remove sick. PTI. <br />A;or Holidays not <br />,:cognized by the <br />County. <br />Tax Employer <br />Contribution <br />Retirement Employer <br />Contribution <br />t mployee's contribution is <br />reflected in gross <br />Total <br />Calculated <br />Percentage <br />of Total to be <br />Requested <br />Total Requested <br />1Ga"i <br />r. <br />1Gah: <br />1Ga't <br />1GtY"y" <br />5 <br />1Ga'i. <br />5 <br />1G(yL <br />5 <br />S <br />c <br />S <br />C <br />r <br />S <br />r <br />r <br />� <br />r <br />LEI] <br />< <br />C <br />I <br />Is <br />r <br />'Expenses must intrude itemued original invoice and receipt ur car celed aleck as pruut of paymen.. <br />*Salaries must show a breakdown the hours paid by type (e.g., regular, sick, vacatio6). Please now the County will NUI Rcirnbutse for SICK or VACATIDN <br />tlr^te so otiose must be deducted from the request prior to submitting <br />