HomeMy WebLinkAbout2010-315 INDIAN RIVER COUNTY
FOOD AND REFRESHMENT
DISCLOSURE FORM
SECTION 104 . 06 ( 5 ) ( b ) ( 2 ) OF THE COUNTY CODE
I consumed food and / or refreshments at a single sitting or event ,
the cost of which may have exceeded the per diem allowance under
Chapter 112 , F . S . , as follows :
Date of subject event : Xsmo
Meal ( circle one ) : breakfast , lunch , inner
Provided by : �"�^ ��
Signature :
Printed n e :
Date : / Z /
INDIAN RIVER COUNTY
FOOD AND REFRESHMENT
DISCLOSURE FORM
SECTION 104 . 06 ( 5 ) ( b ) ( 2 ) OF THE COUNTY CODE
I consumed food and / or refreshments at a single sitting or event ,
the cost of which may have exceeded the per diem allowance under
Chapter 112 , F . S . , as follows :
Date of subject event :
7- r __
Meal ( circle one ) : Cnne_breakfast , lunch , r
Provided by :
Signature :
Printed n e :
i
Date :
INDIAN RIVER COUNTY
FOOD AND REFRESHMENT
DISCLOSURE FORM
SECTION 104 . 06 ( 5 ) ( b ) ( 2 ) OF THE COUNTY CODE
I consumed food and / or refreshments at a single sitting or event ,
the cost of which may have exceeded the per diem allowance under
Chapter 112 , F . S . , as follows :
Date of subject event : Xsmo
Meal ( circle one ) : breakfast , lunch , inner
Provided by : �"�^ ��
Signature :
Printed n e :
Date : / Z /