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INDIAN RIVER COUNTY <br />CHILDREN'S SERVICES ADVISORY COMMITTE <br />REMBURSEMENT REQUEST- FY25 26 <br />Agency <br />Adfress <br />Emall <br />Prograrn <br />Phalle <br />=ax <br />REQUEST 0 <br />Payment <br />Tax Employer <br />Retirement Employer <br />Total <br />Percentage <br />Payee Venlor <br />Pay Period <br />Gross Salary <br />of Total to be <br />Total Requested <br />Date <br />Contribution <br />contribution <br />Calculated <br />Requested <br />"Remove sick, PTO, <br />a.d/orHolidays not <br />'Employee's coatributim is <br />recognized by the <br />reflected in gross <br />County. <br />5 <br />lao4� <br />5 <br />- <br />S- <br />S- <br />S <br />- <br />1a01;� <br />- <br />S - <br />S - <br />S <br />5 <br />S <br />S <br />5 <br />S <br />5 <br />S <br />S <br />S <br />'Expenses must in:lude itemized original Invoice and receipt or carceled check as proof of payrnow. <br />*Salaries must shown breakdown 1he hours paid by type (e.g., regular, sick, vacatloa). Please note the County will NOT Reimburse for SICK or VACATION <br />time so those must be deducted from the request Frlor to submitting <br />