HomeMy WebLinkAbout2011-038 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 :
Meal ( circle one : breakfast ,
lunch , inner
Provided by : A' r ct4
l
signature : 4& - --
Printed name : G�C �"
Date :