Board Honoraria/Expense Claim FormBoard Name A LUS P&C

Month Ended j Lz + ca ?2

Name y3v4e4 c41c Approved by

______________________________

- Mileage Other Expenses MEALSDate Details Time Honoraria — — —“l Hotel Other B L D $ Amt

3LatL;1jI ALLSPAC 3.asvrs %LiU 3XJ EEEAjvof-%/IL AU1ts PAC ;- d.jxr 7D E E

DOD

COD

CCC

ODD

ODD

ODD

ODD

DOD

DOD

ODD

DCC

ODD

O9j4 EEETOTALS a 3tj. tow...

Notes

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:

_______________________________________

oc

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

1 [ao C TOTAL CLA Qnc,m

Board Honoraria/Expense Claim Form• erdNarneDA?)

Z\iT 2oIName flxrt McvoAd

Approved b

-, I . viFIeae Other Expenses MEALSDate s Time Honoraria

, Hotet Other B L D $Amtj/1 OATh ESDCC

ODD

DOD

ODD

ODD

DOD

0 H D

:on

ODD

ODDF- ODD

TOT IS

I heeoy cert.fy tht in. wl,oie o inc evoece- rule was incajrred on - - . bdsiress that earh item ‘iven is correa, and tea: arsiJrts Claimed have not previousLy beee paid to meSt Sn my ce5 a!I

ZT

Za

cta

r

•0 •0 0 C Co a 0

0 Di a 0 0 Di Di m -c C,

I, n Di 3 1,

0 3

‘

7 I a C C S a 0

0

0 S z 3 0 a 0 0 S 0 V a 0 S

]

Vi

7)p

-0

C’)

V V C C S a 0

0)0w

r

zza

3(03

0a

(0

a 3 0 3 a 0 a 0 3

0 ci a I 0 0 0 0) 0) F”

(0 0 (0 n 0) 3 0 3

U 0) (02 0) C

•0 0 C (0 a 0

r C 0 C n 0 C C z 0 3 0 3 a 0 t C C C t a 0

oo

zm

zD a

3’o3

ita

o

xl.S

p

.1

C a C 0 ‘C •0 it ‘O n 0) 3 ,, 0 3

Cr

00 0 02 C C

V •0 0 C it a

0

;.033;;Ci0d\331S2flL3ddION3AF031\ItlDSiVOV.stHiOtE3dCDSI\]0LDt0SEEEEE.r:-_rEEr:-ICh1Ed.’V1VIOI

V&cdC0abteC’?

[Il1/f

h—i-—•—L

YSUJ9OUO3SiaXedJO

——

—

.uoLuaoue..o.V.o:ED

i

&I;1tf IfS0£tODtrErrrr-::-_-rrErE:-r:--:r-

SiftED

dJHIO931OHS1V3VSJ\>13HIO9C2d\10100CM9SVN3ANOD\iCiiY10D3\Ii

VIVii1VIOI7!-2CI/

9Jqa’OIoJAed

ASQSAObddV9179g.’C]C3H°i/ti

VOdNW1D-3SN3dX3/VIHVHONOH-0VO2/S1’(DWO0310313

14/c,fl,Aoproved b

Mileage Other Expenses MEALS

DataDeta’s

rime HonorariaI(ims) Hotel Other B L 0 $Amt

A/b2i (ppc’1

CC

COP

ODDr___ JEEF 000I-

II I_____

DOD.

DDD

____

.

EEDJ____i Dcc

DDc____

0001I DOD

FITC.nS

ThtaI Honorariaa2 7/.

Total Esponces

Total Mileage $-

TOTAL CLAIM AMT: 5’03 ypDate: fl’2i ia .O/fSignature:

C) flfl)Month r—

Board Honoraria/Expense Claim Form

Macn

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: