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INBAN RIVER COUNTY <br />CH1DREN'S SERVICES ADVISORY COMMITTE <br />REMBURSEMENT REQUEST -FY25 26 <br />aUJnM„ <br />P•ugrruri <br />P+� u lie <br />REQUEST $ <br />"aymeot <br />Date <br />Payee:Venjo, <br />s', <br />Gross Salary <br />'Remove sick, PTO, <br />aadtor Holidays not <br />recognized by the <br />Count\,. <br />TaxEn4Moyer <br />Contribution <br />R*UrwrantEmploy r <br />COntrUmdon <br />mployee's contributroi <br />reflected in gross <br />Total <br />.-alculated <br />Perrentagr <br />of Total to be <br />Requested <br />Totat Requested <br />lO0`c <br />S <br />S <br />IOOAt <br />S <br />S <br />1001t <br />S <br />5 <br />100E <br />5 <br />5 <br />10a`ti <br />5 <br />r <br />100' : <br />s <br />5 <br />5 <br />S <br />S <br />S <br />S <br />S <br />S <br />5 <br />> <br />5 <br />S <br />S <br />5 <br />5 <br />S <br />S <br />' Expenses must in:tude itemized origmal invoice and receipt or carceled check as proof of paymew. <br />. Sltlanes must show a breakdown the hours pard by type (e.g.. regular, sick, vacaboo). Please note the County MR NOT Reimburse for SICK or VACATION <br />time so those must be deducted from the request Friot to submitting <br />