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Cz <br />nn ^n — <br />Date Description Charges I Credits <br />U5 -31 -09 <br />+ <br />V V-UJ-UU <br />David Galat Folio No. 65755 <br />Room No. <br />303 <br />US A/R Number <br />Arrival <br />05 -31 -09 <br />Group Code <br />Departure <br />06.03 -09 <br />Company Headwaters Corporation <br />Conf. No. <br />64515688 <br />Membership No. <br />Rate Code <br />IGCOR <br />Invoice No. <br />Page No. <br />1 of 1 <br />Date Description Charges I Credits <br />U5 -31 -09 <br />`Accommodation <br />05 -31 -09 <br />State Tax - Room <br />05 -31 -09 <br />Bed /Occupancy Room Tax <br />06 -01 -09 <br />'Accommodation <br />06 -01 -09 <br />State Tax - Room <br />06 -01 -09 <br />Bed /Occupancy Room Tax <br />06 -02 -09 <br />'Accommodation <br />06 -02 -09 <br />State Tax - Room <br />06 -02 -09 <br />Bed /Occupancy Room Tax <br />06 -03 -09 <br />MasterCard <br />XXXXXXXXXXXX3488 <br />Total <br />129.99 <br />7.80 <br />; <br />1 <br />5.20 <br />129.99 <br />`nG <br />7.80 <br />}°` <br />5.20 <br />129.99 <br />9q <br />7.80 <br />5.20 <br />428,97 <br />428.97 428.97 <br />Balance 0.00 <br />Guest Signature: <br />I have received the goods and / or services in the amount shown heron. I agree that my liablity for this bill is not waived and agree to be held <br />personally liable in the event that the indicated person, company, or associate fails to pay for any part or the full amount of these charges. If <br />a credit card charge, I further agree to perform the obligations set forth in the card'holder's agreement with the issuer, <br />Holiday Inn Express Hotel and Suites <br />1741 Fleischli Parkway <br />Cheyenne, WY 82001 <br />Telephone: (307) 433 -0751 Fax: (307) 433 -0761 <br />