DR 2395 (04/02/15) COLORADO DEPARTMENT OF REVENUE ...
10. I certify that this claim is true and correct to the best of my knowledge and belief and that payment or credit has not been received by me. DATE. CLAIMANT ... Optional Form 1164 - Claim for Reimbursement for Expenditures on Official Business Created Date: 6/25/2019 3:20:02 PM ... ................
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