I. · elected officials/board-honoraria/expense claim form month ended: approved by: payroll i date...
5
Name: -c w’r Date Details Cssv ) 3r 4 L f\ \/ 4 ___M. . C Elected Officials/Board - Honoraria/i xpense - Claim Form Month Ended: 20 . 4 MEETINGS LARB/ PC CARB M Convent. Approved by:. ASB iirnc Council Admin DAB / l6.0.0 OTHER KM’s ‘ .l e€ B XP NZS .AFAIS I. D $Arnt HOTFI 1 OTHER I z — -) - 1 hereby certify that the wh e f the expenditure was incurred on County business, that each item given is correct, and that amounts claimed have KM’ not previously been paid t me ron my behalf. s. — Signature f°0! Date: $
Transcript of I. · elected officials/board-honoraria/expense claim form month ended: approved by: payroll i date...
Name:
-c w’r
Date Details
____
Cssv)
3r 4
__
L
___
f\ \/ 4 ___M. . C
Elected Officials/Board - Honoraria/i xpense - Claim Form
Month Ended: 20 . 4
MEETINGS
LARB/PC
CARBMConvent.
Approved by:.
ASBiirnc Council Admin DAB
/
l6.0.0
OTHER KM’s
‘ .l e€
B
XP NZS
.AFAIS
I. D $ArntHOTFI
1
OTHER
I
z
— -)
___________________
-1 hereby certify that the wh e f the expenditure was incurred on County business, that each item given is correct, and that amounts claimed haveKM’not previously been paid t me ron my behalf. s. —
Signature
_____ ______________
f°0!
Date:
___________
$
Ja1ad)NI
•Lb)
:ivi1vJoI
:)GAOHddV
II0Md
h(0?5f
:Q
:flJJ
I
:3w
7VHAVNOiO3VOIOWdN3A7SflOIMHUIONAVHG]VIV1DSINflOVNIVHIGNV‘DHODSINAID3IIHDVIVH1’SSNISflAINflODNOO1flJNIWMflIIONdXH1dO1OH’HIIVH1idLH3DASHHISSNdX7VIOI
VIVbONOHVDi
5?5-Lci
X
çy05/.fluow/sAepxsuiauosJaAedaHIuo!1daJd
,PW2—
qWOW/a]Uf.OvUO!J!UflWWO)
t7________________________
: i_wvSivD
slIvuaI3H1O7ILOHS7V]V1SW)IHHIOUVODd/UiV7USV1NANODNIwOY7DNflODW)I
QTOAO
tAJHOILi’JIV])-SNdX/VI)IVJONOH-GIVOIS7VDWOG±D73
ELECTED OFFICIALS/BOARD - HONORARIA/EXPENSE - CLAIM FORM
MONTH ENDED: APPROVED BY:
Payroll
I
TIME COUNCIL ADMIN CONVENT. ASB LARB/ MPC DAB OTHER KM’S MEALS______ HOTEL OTHERDATE DETAILS CARBB L D $AMT
. / )‘TTAL YVJy M-r— —
-7$,4]L— —
—
c—
0
Communication Allowance/month— — —
Preparation/Rate Payers Concerns x 2 days/month
TOTAL
‘!kmsx.
TOTAL HONORARIA TOTAL EXPENSESHEREB’!’ CERTIFY THATThE WHOLE OF ThE EXPENDITURE WAS INCURRED ON COUNTY BUSINESS, THAT EACH ITEM GIVEN IS CORRECT, AND THAT AMOUNTS CLAIMED HAVE NOT PREVIOUSLY BEEN PAID TO ME OR ON MY BEHALF.
SIGNATURE:
a
7;NAME: C_ i t/I,4 A I
DATE: / ½ TOTAL CLAIM: V/ INK POT RW 04381
IOt’#d3dlOd)N
,,:viIy1oivioi
i)
_____
:flJyJ5
dJVH39AJNOeIO3J01GIVUN339A7SflOIA3eldION3AVHG3VIV13S1NflOVVIYHIGNV1D3HO3SINAI9N]IIHDV3IVHI‘SS3NISINcwNOG3èIèIflDNISVM3èIflIICN3dX33H1dO37OHMH1IVHIAdl1dDA93H31-IIa/Vivioi
VIdVdONOH1VIOI--L1L.,.
rCL]XSW
JV1OI Q-.c.quow/sicepXSUi83UO3sJoAecI
$i’——
qUOW/e3UeMOIIVUOfl3!UflWWO3
\jj(9]
)wç 795)7/ivvaiTI-O-99OIIIC99ZQI-O-E9OIIOCZQtIOQtWO —
—
S7IVI3G31V0
èI]HIO7310HS7V3IAJS.V1eJH109Va3dV10700CM9SV1N3ANO3NIV10V7I3Nfl033VLI1 eqeAesuno7v
‘IC3AOHddV
IIOJAed
jW
:aaN3HINOV’i
JiOdVJIV73-3SNdX/VIeIVdONOH-ae1VO/S1VI3WOG3I3]7
3VN
ELECTED OFFICIALS/BOARD - HONORARIA/EXPENSE - CLAIM FORM
NAME: t )1& d MONTH ENDED: APPROVED BY:_
Accounts PayableTIME COUNCIL ADMIN CONVENT. ASB WOODLOT MPC DAB OTHER KM’S MEALS______ HOTEL OTHERDATE DETAILS
52-11cD151 02-lil 112 02-11-31454 145230111 0352:0114 3066-tI-ill 02-66-02-151 0241-50-153 B L D $ AMTrn1c-’-’.t f-est-v !351:E i3’qi-’
a—
i4c?.
<4s___
-__K-----
- - -_
Communication Allowance/month— — —
Preparation/Rate Payers Concerns x 2 days/month—
TOTAL
kmsx=TOTAL HONORARIA
TOIALA/P %iDI HEREBY CERTiFY THAT THE WHOLE OF THE EXPENDITURE WAS INCURRED ON MD BUSINESS, THAT EACH ITEM GIVEN IS CORRECT, AND THAT AMOUNTS CLAIMED HAVE NOT PREVIOUSLY BEEN PAID TO ME OR ON MY BEHALF.
DATE: -),4 ø2Y%tic,2 L d211 % TOTAL CLAIM: / 7’
Payroll
SIGNATURE
ISV. POT REF# R2401
