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Kittitas County — t&1 Grant <br />Law &Justice Grant Reimbursement <br />When submitting for reimbursement, please complete the following information to accompany your <br />invoices. <br />Please send requests to- <br />Kittitas County Auditor <br />Attn. Accounting Department <br />205 West 5 Ih _ Suite 105 <br />W <br />Ellensburg A 98926 <br />0 <br />/'N <br />L <br />Date <br />Grant Number <br />17-1-7 <br />Name & Address of Organization <br />0 <br />MO -0e -P <br />Requesting Reimbursement <br />A/ S � V IQ 6 4, jC' *o i <br />Entered into Spreadsheet - initials <br />12 0 T Cep 17-O'L <br />Name of Person submitting Request <br />Alf -14- ML4S4 <br />Contact number <br />67o 1. yj 9. 95 -Cl <br />Amount of Reimbursement <br />4<11� <br />L.5 0 <br />If you have questions, please contact Auditor's office- 509-962-7502 <br />Anditnr­'q r)ffirp tmo niniv <br />Total Authorized <br />-Amount of this request <br />Previous amount requested this year <br />Balance Left <br />Entered into Spreadsheet - initials <br />1 Auditing Officer initials <br />N, A <br />