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INDIAN RIVER COUNTY <br />CHILDREN'S SERVICES ADVISORY COMMITTE <br />REIMBURSEMENT REQUEST - FY25.26 <br />Agency <br />Adiress <br />Ercall <br />Program <br />Phone <br />:ax <br />REQUEST # <br />Payrnent <br />Date <br />Payee jVendor <br />Pay Period <br />Gross Solari' <br />`Remove sick, PTO, <br />aed/Dr Holidays not <br />recognized by the <br />County. <br />Tax Employer <br />Contribution <br />Retirement Employer <br />Contribution <br />'Employee's contribution is <br />reflected in gross <br />Total <br />Calculated <br />Percentage <br />of Total to be <br />Requested <br />'total Requtsted <br />S <br />100% <br />S <br />$ <br />100% <br />S <br />$ <br />100% <br />S <br />$ <br />100% <br />$ <br />- <br />5 <br />1004 <br />S <br />- <br />S - <br />S - <br />S <br />$ <br />s <br />s <br />S <br />$ <br />S <br />$ <br />- <br />S <br />S <br />S <br />Is <br />Expenses must in.lude itemized original invoice and receipt or carceled check as proof of paymen-:. 5 <br />• Salaries must sham a breakdown he hours paid by type (e.g., regular, sick, vacatioe)• Please note the County will NOT Reimburse for SICK at VACATION <br />tirne so those must be deducted from the request Friar to submittlr>g <br />