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INIMAN RIVER COUNTY <br />CHILDREN'S SERVICES ADVISORY COMMITTE <br />REMBURSEMENT REQUEST- FY25 26 <br />Agency Program <br />Adiress Phone <br />Er'rait =ax <br />REQUEST 4 <br />Expenses must in.tude itemized original invoice and receipt or carceled check as proof of paymerr_ <br />' Stlaryes must share a breakdown the hours oa€d by type le. g.. regular, sick, vacation). Ptease note the County wi It ?i OT Rei mburse ro, SICK u� VACAT UN <br />time so those must be deducted tram the request Frior to submitting <br />Tax Employer <br />Retirement Employer <br />Total <br />Percentage <br />Payee/Vendor <br />Pay Period <br />Gross Salary <br />of Total to be <br />Total Request; <br />Contribution <br />Contribution <br />Calculated <br />Requested <br />'Remove sick, PTO, <br />andlorHolidays not <br />' Emvloyee's contribution is <br />recognized by the <br />reflected in gross <br />Count <br />110C'' <br />S <br />S <br />100'i <br />S <br />S <br />1GC'i, <br />S <br />S <br />1QC�i: <br />S <br />loc, is <br />S <br />S <br />S <br />S <br />S <br />S <br />5 <br />S <br />S <br />S <br />5 <br />S <br />S <br />S <br />5 <br />S <br />S <br />S <br />5 <br />Expenses must in.tude itemized original invoice and receipt or carceled check as proof of paymerr_ <br />' Stlaryes must share a breakdown the hours oa€d by type le. g.. regular, sick, vacation). Ptease note the County wi It ?i OT Rei mburse ro, SICK u� VACAT UN <br />time so those must be deducted tram the request Frior to submitting <br />