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Document cortlandcountyny_gov_doc_716dca782d

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CORTLAND COUNTY CHILD’S NAME DEPARTMENT OF SOCIAL SERVICES MONTH OF FOSTER PARENT MILEAGE SHEET CASE NUMBER TRIP DATE *REASON FOR TRIP LOCATION FROM LOCATION TO TOTAL MILES 45¢ PER MILE *medical, dentist, counseling, etc TOTAL Please submit mileage sheets for reimbursement within 90 days of rendering the services or payment will not be made. Foster Parent Signature Supervisor Signature Caseworker Signature Director Signature