Laserfiche WebLink
INDIAN RIVER COUNTY <br /> FOOD AND REFRESHMENT <br /> DISCLOSURE FORM <br /> SECTION 104 06 ( 5 ) ( b ) ( 2 ) OF THE COUNTY CODE <br /> I consumed food and / or refreshments at a single sitting or event , <br /> the cost of which may have exceeded the per diem allowance under <br /> Chapter 112 , F . S . , as follows : <br /> Date of subject event : <br /> '3bo / I / <br /> Meal ( circle one ) : breakfast , lunch , dinner <br /> Provided by : ( fAL) <br /> Signature : <br /> Printed name : Pe, <br /> Date : 3 � � ► / � � <br />