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Claim And Verification Form



 
 
 
 
 
 
 
 
 
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Give a brief description of the service performed.  Include answers to who, why, what, where and when.
 
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* This section shall serve as your electronic signature. I declare under the penalties of law that the expenses claimed are actual, correct and that no payment has been received or will be claimed for same expenses.
     
     
 
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Note:  All receipts and other supporting documentation must be submitted to the Eveleth-Gilbert Business Office before this for can be processed.
 
 
 
 
 
 
 
 
 
 
 




  Send a copy of the completed form to this email address : 


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