HomeMy WebLinkAbout2011-074 INDIAN RIVER COUNTY � v I f � ` ' `
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 : ' I
Meal ( circle one ) : breakfast , lunch , dinner
Provided by : / ��_ � � �1°--�
Signature :
1
Printed name :
Date
INDIAN RIVER COUNTY � v I f � ` ' `
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 : ' I
Meal ( circle one ) : breakfast , lunch , dinner
Provided by : / ��_ � � �1°--�
Signature :
1
Printed name :
Date