Board Honoraria/Expense Claim FormBoard Name A LUS P&C
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Name y3v4e4 c41c Approved by
______________________________
- Mileage Other Expenses MEALSDate Details Time Honoraria — — —“l Hotel Other B L D $ Amt
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Total Honoraria 34cc
_______
Total Expenses -
Total Mileage— .__2L,_—.. —
TCTALCLAIMAMT: 3 Q, —
_________________________________________________________________________
Date:
___________________________________________
her&, renay that the whole of the expend.ture was incuaedon Cart, ei. that each item gwen is correct, and that amounts ciaimed have nd previojsly been paid tomeoronmybatialt Signature:
_______________________________________
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ELECEDOFF!CIALS/BOARD-HONORARIA/FXPENSE-CLAIM FORM
MONTH ENDED:
_____________
oIAPPRO V ED BY:
E— —EWHOLEDEThEPENDFRiRE WAS INCURREDON COUNTYBUSINESST_ATEACH
SG\AJRE:
_______________________________________________
DATE:
Payroll.
- TIME COUNCIL ADMIN CONVENT) ASS LARE! MPC DAB OTHER KMS J MEALS HOTEL OTHERDAZE DEiZ-CARB
3 3 0 $AMT
Conwmadcadan Mowaicehnonth— —
— 7500
Pe..iaAV Pae% CanCans x 2 daWmonlh— —
1UWL
8BkrnSX 39732
ITEM GWEN IS CORRECt, ANDTHAT AMOUNTS CLAIMED HAVE NOT PREVIOUSLY BEEN PAIDTO ME OR ON MY BEHALF.
TOTAL EXPENSES
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Mileage Other Expenses MEALS
DataDeta’s
rime HonorariaI(ims) Hotel Other B L 0 $Amt
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Total Esponces
Total Mileage $-
TOTAL CLAIM AMT: 5’03 ypDate: fl’2i ia .O/fSignature:
C) flfl)Month r—
Board Honoraria/Expense Claim Form
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bereoy tanfg that the whole of the eupendirure was incurred ;n a- bJtlnett, that rash ten given is tarrert. and that amounts claimed hase not previously been paid to memy behalf
Doord Honoraria/Expense Claim orm
.pprovi’cI by:
-r I Mileage Other Expensea MEALS
DateDote’ c
Time H000rara,
lkml Hotel ( Other D AmtG-\c pr00D_____
-
H
I
900
li 9I
EIE°1DVLS
0
Totci Honoraria goTotal ErpenserTotal Mileage S 4TOTAL CL4IM AMT: r 03 4 fl
Date;
Signature:
No
reeoy ctt fy char he whoae of the eapenditure was incurred on County bJsrean. that each ‘ten’ tear a correct, and tiat 00cm! S claimed have not p’ev’oIsiy been paid to me
2 / APPROVED BY:
SiGNATURE:
__________ ______________
DATE:
NAME: /c± 4Z.tiAJJ5
ELECTED OFFICIALS/BOARD - HONORARIA/EXPENSE - CLAIM FORM
MONTH ENDED:
TOTAL GA{M: