Fillable Medina County Commissioners Cell Phone Stipend Request Form (Medina County)

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Medina County Commissioners Cell Phone Stipend Request Form (Medina County)

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The Medina County Commissioners Cell Phone Stipend Request Form (Medina County) form is 1 page long and contains:

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Country of origin: US
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I have received approval from the County Administrator and the Board of
Commissioners to receive a monthly stipend paid on a quarterly basis per the
County Cell Phone Policy 7.007.
The quarterly amount is _____________ to be paid for ____________quarter.
Employee Signature
Department Head/Commissioner
Name: _______________________________________________________
Home Address: ________________________________________________
City: _____________________ State: ____________ Zip Code: _________
Medina County Commissioners
Cell Phone Stipend Request Form
Medina County Commissioners | 144 N. Broadway St., Suite 201 | Medina, OH 44256 | www.medinaco.org
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Medina County Commissioners Cell Phone Stipend Request Form (Medina County)

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Completed 8 February 2021

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