HomeMy WebLinkAbout2012-120 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 : / Z �l
Meal ( circle one ) : breakfast , lunch , dinner ` -�
A
Provided by :
Signature :
Printed name : G �Cl�
Date :