Dependent Care Statement Of Expenses

Dependent Care Statement Of Expenses

Dependent Care Form

Name

Name

First

First

Last

Last

School

Date(s) of Meeting

Caregiver name/Facility

Number of hours required for Dependent care

Start time

End time

Total hours

Mailing address for cheque

Mailing address for cheque

Mailing address for cheque

Mailing address for cheque

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Country

Country

Signature

Please note that according to Council Policy C11 X11 – (if this expenditure is for a Council meeting it shall not exceed 3.5 hours.)

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