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S F5 -S <br />t,- <br />FQrL, <br />4 <br />MTii CA l'V71' <br />Kittitas County — L&J Grant <br />Law & Justice Grant Reimbursement <br />When submitting for reimbursement, detail copies of invoices are required to accompany this form and <br />please complete the following information to accompany your invoices. <br />Please send requests to: <br />Kittitas County Auditor <br />Attn: Accounting Department <br />205 West 5th —Suite 105 <br />Ellensburg WA 98926 <br />auditorsaccounting(@co.kittltas.wa.us (please place M Grant reimbursement in subject line) <br />Date <br />Grant Number <br />Name & Address of Organization <br />Requesting Reimbursement <br />Name of Person submitting Request <br />and Contact number <br />Amount of Reimbursement <br />If you have questions, please contact Auditor's office 509-962-7621 <br />Auditor's Office use aniv <br />Total Authorized <br />$ <br />Amount of this request <br />$ <br />Previous amount requested this year <br />$ <br />Balance Left <br />$ <br />Entered into Spreadsheet - initials <br />Auditing Officer initials <br />1/2018 <br />