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INDIAN RIVER COUNTY <br />CHILDREN'S SERVICES ADVISORYCOMM"TE <br />REIMBURSEMENT REQUEST- FY25.26 <br />Agency <br />AdIress <br />Errait <br />Program <br />P r I L, Ile <br />REQUEST <br />;Iayment <br />Payet) Vendor Pay Period <br />Gross Salary <br />Tax Emplayer <br />Retirement Employer <br />Total <br />Percentagt <br />ofTotal tobe <br />Total Requ-sted <br />Date <br />cuntri butien <br />Contribution <br />CaLcutated <br />Requested <br />'Pernave sick, PTO, <br />3-djar Holidays not <br />Employee's contribution is <br />recGgnized by the <br />refected in gross <br />County. <br />S <br />10014: i-1 <br />S <br />1001k <br />1001k <br />1001t <br />10011L <br />S <br />10G`li <br />S <br />S <br />S <br />$ <br />S <br />S <br />S <br />$ <br />S <br />S <br />...rM—UZ i I [UsL it I�WUU IMIMAUU UJ1WJjCjtj11VUJLVdiol I ULUIPL UF Cal-CeIeU Cnel;K as pr CTT payrnew.. <br />*Salaries must ShOW a breakdown Ihe hGUrS paid by type (e -g., regular, sick. Vacation)_ Please note the County vAtf. " Reimburse for SICK or VACATION <br />titre so those must be deducted Itam the request rtior to submitting <br />