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INDIAN RIVER COUNTY <br />CHILDREN'S SERVICES ADVISORY COMMITTE <br />REMBURSEMENT REQUEST- FY25-26 <br />Agency Program <br />AdIress Phone <br />Err ail =ax <br />REQUEST 11 <br />*Expenses must in.Lude itemized original invoice and receipt or carceled check as proof of payrnerr.. <br />*Salaries must show a breakdown 1he hours paid by type (e.g., regular, sick, vacation). Please note thO County evil,[ NOT Reirriburs L, to, SICK or VACATIDN <br />time so those must be deducted from the request Prior to submitting <br />Percentage <br />>ayment <br />Tax Employer <br />Retirement Employer <br />Total <br />Dat. <br />Pavoei'Venlor Pay Period Gross Salary <br />Contribution <br />Contribution <br />calcu(at ed <br />ofTotal tobe <br />Total Requ�sled <br />Requested <br />-Remove sick, PTO, <br />a,dl'ar Holidays not <br />'Employee's contribution- i-. <br />recognized by thE <br />reflected in gross <br />f ountV. <br />S <br />10011: <br />S <br />100ki <br />5 <br />C <br />100�i- <br />S <br />10041 <br />S <br />S <br />S <br />*Expenses must in.Lude itemized original invoice and receipt or carceled check as proof of payrnerr.. <br />*Salaries must show a breakdown 1he hours paid by type (e.g., regular, sick, vacation). Please note thO County evil,[ NOT Reirriburs L, to, SICK or VACATIDN <br />time so those must be deducted from the request Prior to submitting <br />