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INDIAN RIVER COUNTY <br />CHILDREN'S SERVICES ADVISORY COMMTITE <br />REMBURSEMENY REQUEST- FY25.26 <br />Agency <br />Ad9ress <br />Errail <br />Program <br />Ma Ile <br />REQUEST O <br />?aynent <br />Date <br />Pa ee Vendor <br />Pay Period <br />Grow 5alary <br />kemove sick, PTO, <br />aid}or Holidays not <br />recognized by the <br />CountV. <br />Tax Employer <br />Contribution <br />RetiremgntEmpltVti° <br />Contribution <br />"Employee's contribution is <br />reflected in gross <br />Total <br />Calculated <br />Percentagee <br />of Total to be <br />Requested <br />Tota( Requested <br />- <br />S <br />1017'i <br />S <br />S <br />100VL <br />$ <br />S <br />100tI: <br />5 <br />S <br />100"i: <br />S - <br />S <br />10044: <br />S <br />- <br />S - <br />S <br />S <br />$ <br />S <br />S <br />S <br />S <br />S <br />S <br />S <br />S <br />tspenses roust m:iude itemized ongmai invoice ana receipt or carcelea check as prGor of payment. <br />Salaries must shore a breakdown the hours paid by type (e.g., regular, sick, Vacation). Please note the County win NOT Reimburse tar SICK er VACATION <br />tires so those must bededucted from the request grlor to submitting <br />S <br />