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INDIAN RIVER COUNTY <br />CHILDREN'S SERVICES ADVISORY COMMITTE <br />REIMBURSEMENT REQUEST- FY25 26 <br />AgLiney <br />Ad7ress <br />Ewalt <br />P•urrun <br />P'iune <br />-0x <br />REQUEST q <br />?ayment <br />Date <br />Payee Vendor <br />Ray Period <br />Gross Salary <br />'Remove sick, PTO, <br />aad;or Holidays not <br />recognized by the <br />County. <br />Tax Employer <br />Contribution <br />Retirement Employer <br />Contribution <br />`EmployWs contribution i <br />reflected in grrs= <br />Total <br />calculated <br />Percentage <br />of Total to be <br />Requested <br />Tota( Requested <br />10(N1 <br />S <br />100k� <br />5 <br />= <br />100: <br />5 <br />100: <br />5 <br />5 <br />S <br />5 <br />f <br />r <br />J <br />f <br />r <br />'Expenses must in:tudu ttenuzed original invoice and receipt w carceled check as proof ut payrnen.. <br />`Salaries must show a breakdown the hours paid by type (e_g_, regular, sick, vacation). Please note the County wilt NOT Reimburse for SICK or VACATION <br />time so those must be deducted tram the request Krlor to submitting <br />