Form B-41 - Sample Form -Judges Expense Bill - Pay Sheet

ADVERTISEMENT

SAMPLE FORM
JUDGES EXPENSE BILL - PAY SHEET
To be filled out and returned to the Designated Election Official with all other election materials.
District
State of Colorado
Claimants Name and Mailing Address
Service
Amount Claimed
Total
TO:
Supply Judge of Election
_________________________
______________________________
Social Security No.
_________________________
TO:
Judge of Election
_________________________
_______________________________
Social Security No.
_________________________
TO:
Judge of Election
_________________________
_______________________________
Social Security No.
_________________________
TO:
Judge of Election
_________________________
_______________________________
Social Security No.
_________________________
TO:
For: ____________________
Social Security No.
_______________________________
_________________________
TO:
For: ____________________
Social Security No.
_______________________________
_________________________
We, the undersigned Judges of Election in said
District,
certify that we served as Judges of Election at the Regular/Special Election on
, 20
.
(Signature)
(Signature)
(Signature)
(Signature)
Division of Local Government
B-41

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go