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Office of Administration Commissioner's Office tcanteac rind uly 1,2015~ june 30,2016 “Request for Preauthorization for Other Services” Program: Alteatives'ta Abortion CContractine_ Alliance fer Jif Missa Ine Subconteactor:_Rathany Christin Services of Mss Please enter belew the infoematlon for ach i puchasee| provided to Le relmbursed, teehee si/servica tobe puneacr. Uistthe date of purchase ftens tobe prnchused, one for Eh itom, ad che justifcalon, Teme rout be apr hore chentcme RE ate Gnrvtted_517 2016 aT aE Total Goat (Gelade formal estimate ‘wow provider of survives) jostieadoninclode | ‘other courves 9 Funding thathave boon tempted, 2p Feb Ca Tosuiance | [39999 [ eet ors fa ae buts curnently on leave afer having ner sonin December via e-seeaon, ‘Shedues not have paid raternity eave ant snceds assistance paying her capinsurance, es maintsines Tnerjob at Stet» Shake for 7 yuars ands very Inge worker. She bas Tbeen commuter ba her Involvement in the AA ‘pragrain and bas been tnrilled since May 2016, wwhas needed very ssisance BOT to her habyrand 9 facomin coming in duvto beng on eave, There are vie other Facing sourens fralsotaeareto | [ aoitso be Feinnorsea help with talsneed. | he suahostead person roquetigpatchisg: Almas races, Date 22/2042 fate prog Marge Acasa flideldteées— lane Pepoice tj bie? Dee flag Purcse dent: 7 i essen for dengingpurchases 0 FDoneastt0. (ecb Sze at cs 1ap.gg0500 2-906 FISGELL, BRITTANY 63 WESTRIDOELN SAINT ANN MO 6074-304 we otal cH a ‘ipattintormatin Lhe or ag We oct era ON favs oa 96 IRN, 257. “Tenis for etting us serve you! Bll cae baer ur ore. ichavoteqnismnoice ow osteo, rn pee se rece nei. mnie ese aE. iy Nr ay fan eH oda oi ia er sis ody yo esa Na ‘Total Ainonnt Duce Bue by. oa Si lt ans ches BUR santo WO #9074901" Phone 424-300, al igo cata oe crit ts ost pnt 7 ° _punitaee an 2, Gao. Pies sale sans eyode O ES SS dae! sv nnd ni pee, PRCA ATA eorrosise ean aE Jebaee Saget ote at teu 810 Bik feo Pleasa pay UPON RECEIPT Eula UAatemb eA E 4 tooo wae [raat Te aernnnneoos 3001120205144 1314 &Saterarnr +S sxeediintSamimaty Lestincn lee at Pad iene ‘Gace rtalren roi lint Ore “atl Anount Dua upon Resept " oliy Deals a igo azrse0i2i0 i EVR b> ery rant chon you poi cack aspayman, yous exter nace ayn otha roe ‘a vn your cou non ae san FP Aeon 1.205 48 ster tous tetra ot youre make own donor ae our Tere ns rarnlan Fa our ec la ako an ceo ends ee, indo Poa ryan eye tes yo neck ba am or arden. Paypot® Props ony 1,2