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INDIAN RIVER COUNTY <br />CH LDREN'S SERVICES ADVISORY COMMITTE <br />REIMBURSEMENT REQUEST - FY25-26 <br />Agency Program <br />AdIress Phone <br />Errant :aX <br />payment <br />Oat- <br />Payee/Vendor <br />Pzy Period <br />Gross salar-" <br />Remove sick, PTO <br />a �. d,'o r H cal id arys no t <br />recognized by thi <br />oun-Y. <br />Tax Employer <br />Contribution <br />Retirement Employer <br />Contribution <br />*EMpI0We'SCDntributio <br />reflected in gross <br />Total <br />Calculated <br />Percentagt <br />ofTotattobe <br />Requested <br />TotalRequnte,- <br />S <br />100'- <br />S <br />S <br />1001,v <br />S <br />S <br />100"t <br />S <br />1001Aj <br />S <br />S <br />S <br />J <br />to <br />s <br />S <br />Expenses must in-'tude denWed original invuice and feC101pt Cr canceled check as ptLvuf ut paymeri.. <br />'Salaries must shawa breakdown the hours pard by type le.g., regular, sock. vacabom). Ptease note the County will NOT Reimbtast, for WK or VACATION <br />time so those mst be deducted trom the request rtior to submitting <br />