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Tral Motor Pool PO Box 233 Trenton, NJ 08625-0233 Attention: Thomas Mantel (609) 984-4323 Agency Name: Agency Address: Agency Contact Name: Driver s Name: Home Address: Employee ID #: SG License Plate #: Total Amount of Request: $ (NOTE: Original Receipt MUST be attached to this form) Reason for Emergency Expenditure: Supervisor s Approval: Date: NOTE: Please be sure receipts are dated within one fiscal year (July 1 to June 30) ADMV-100 rev 6/2009.

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