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# Sir holiday Inn <br /> Express <br /> f:‘,4 <br /> &Suites <br /> 3 07-22-14 <br /> Miles Yaw Folio No. • Room No. 223 <br /> 425 W 8th St A/R Number • Arrival 07-21-14 <br /> La-Center Wa 98629-5451 Group Code • Departure 07-22-14 <br /> United States <br /> Company P Y Conf. No. : 64393921 <br /> Membership No. : Rate Code : IMGOV <br /> Invoice No. • • Page No. : 1 of 1 <br /> Date I Description Charges I Credits <br /> 07-21-14 *Accommodation 83.00 <br /> 07-21-14 State Tax 5.81 <br /> 07-21-14 Lodging Tax 2.49 <br /> 07-21-14 Occupancy Tax 1.66 <br /> 07-22-14 American Express 92.96 <br /> Total 92.96 92.96 <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 cardholder's agreement with the issuer. <br /> XCd461-...S 3 ,° O <br /> 413/ir (4' <br /> is <br /> Holiday Inn Express Lexington <br /> 2605 Plum Creek Parkway <br /> Lexington, NE 68850 <br /> Telephone: (308)324-9900 Fax: (308)324-7000 <br />