HomeMy WebLinkAbout2012-217 eJOt AGENAA �—
INDIAN RIVER COUNTY
FOOD AND REFRESHMENT � Q • � a �- �, � '
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 : e,C' z-
Meal ( circle one ) : breakfast , lunch , inner
Provided by : /V 1
c
Signature
-- - - - --Pr-inted--name-. �600' 4
Date * 3 Z.O/ 2
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