COUNTY OF WELD DIVISION OF FINANCE ‘Reimbursement is claimed for personal expenses shown below, which were incured by me in accordance with the relevant provisions of the current Personnel Section of the Weld County Admin ia Agarot3 Print Employee Name Date Em ‘Signature DEPARTMENT HEAD'S CERTIFICATION hereby certify that this claim icin accordance with the relevant Transportation: $0.00 ‘Provisions ofthe current Personnel Section of the Weld County ‘Administrative Code and is to be charged as indicated below. Meals and Lodging: 0.00 Registration Fees: Mileage: 199.47 ‘Other: (s0e2nd pags) 0.00 "nth l2faf te TOTAL CLAIMED: $199.47 Dept. Head's Sighature Ds DETAIL ALL EXPENSES ON THE SECOND PAGE OF SPREADSHEET [New Address/Change of Address: pocumenr # (3170 ‘ACCOUNT # ATTACH ALL SUPPORTING RECEIPTS TO FORM.[roraLs: a Perr ee am 0r14/13 14.9) aa fs ied fees i =] hanna Tt 140) 10/18/13 44.0 aaa vad 1s Horzart3 18.9) jroresri3 18.0] va cat ees ewe a ae ad ele ata sa as aa Al