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INDIAN RIVER COUNTY <br />CHILDREN'S SERVICES ADVISORY COMMME <br />REIMBURSEMENT REQUEST- FY25.26 <br />Ae?ncy Program <br />AdJiess P')Cne <br />Err ail =ax <br />REQUEST It <br />-layment <br />Date <br />6'ayee;'denJor <br />Pay Period <br />gross Saiary <br />' kemove sick, P1 u. <br />3Adtor Holidays nor <br />recognized by the <br />County. <br />Tax Employer <br />+G or*triiaution <br />Retirement Employer <br />Contribution <br />1 f 0: <br />Total <br />Calculated <br />Percentage <br />of Totalto bo <br />Requested <br />Total Requ=sted <br />S <br />10N.- <br />5 <br />ION: <br />5 <br />S <br />10041: <br />5 <br />1Q0I,e <br />S <br />- <br />5 <br />1001t, <br />S <br />5 <br />S <br />S <br />- <br />t <br />c <br />- <br />S <br />5 - <br />5 <br />S <br />r <br />� <br />S <br />.Expenses must In.lude Itemized original invoice and c€ceipt Ur carceted check as proof of paymow. <br />• 5atarees must show a breakdown tie hours peed by type [e.g., regular, sick.,vacation). Please note the County wi u NOT Reimburse rug SICK U;. VACA1 K) u <br />time so those muss be deducted trrim the request pioi to submitting <br />