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["Wyoming Livestock Board"]
["Wyoming Livestock Board",{"$nulls":13},"Claim Form"]
["Livestock Investigation Claim Form July 1- March 31",{"$nulls":13},"Rev 06/19"]
["Complete this form for each investigation for which you are requesting reimbursement.  Attach copies or originals of all supporting documents, receipts, narratives and investigation report forms (in this order).  Tape receipts to 8 1/2 x 11 paper with the county case number in bottom right corner and dollar amount and category in lower left hand corner.  You may tape more than one receipt per page as long as both receipts have the same date.  If necessary use a second claim sheet."]
[null,"DO NOT RECORD LOSS/DAMAGE CLAIMS ON THIS FORM"]
["COUNTY: "]
["Investigation #"]
["Receipt Date - sort in chronological order","Lab Costs",null,"Fuel",null,"MIE",null,"Lodging",null,"Office Supplies",null,"Other",null,null,"TOTAL"]
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[]
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[]
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[]
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[]
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[]
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[]
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[]
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[]
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[]
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[]
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[]
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[]
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[]
[null,"Column Total",null,"Column Total",null,"Column Total",null,"Column Total",null,"Column Total",null,"Column Total",null,null,"Column Total"]
[]
[null,{"v":0,"d":"$0.00"},null,{"v":0,"d":"$0.00"},null,{"v":0,"d":"$0.00"},null,{"v":0,"d":"$0.00"},null,{"v":0,"d":"$0.00"},null,{"v":0,"d":"$0.00"},null,null,{"v":0,"d":"$0.00"}]
["Please do not write below this line.  For Board use only."]
[]
["WLSB STAFF REVIEW",{"$nulls":5},"BOARD REVIEW"]
["Amount Approved: $",{"$nulls":5},"Amount Approved: $"]
[]
["Amount Denied: $",{"$nulls":5},"Amount Denied: $"]
[]
["Total Amount Approved: $",{"$nulls":5},"Total Amount Denied: $"]

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