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86.7. 52.7 CRO-1240 - Refunds and Reimbursements Received

52.7. CRO-1240 - Refunds/Reimbursements to the Committee

1) Organization Name

2) Organization Address

3) Orginal Expense Date

4) Orginal Expense Amount

5) Reversal Amount

6) Reversal Date

7) Reversal Form of Payment

8) Reversal Reporting Description

9) Reversal Button