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Get Employee Reimbursement Request - Jefferson

Ription of Expenditures (Attach original receipts for all items.) Date Vendor Name Item(s) Purchased Amount Total: I certify that the expenses itemized above were incurred in the performance of my official duties and the expenses have not been previously paid. Departmental Charge Code ( Do not cross legal entities) Business Department Unit Account Product (Optional) Amount Employee Signature: Must Equal Total Above: I certify that the expenses itemized above have been reviewed and are.

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