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..—r...... ralj.0 f UI IC <br /> Holiday Inn <br /> T=gi <br /> .: p;:,:;.f Express <br /> y e. <br /> Afivil <br /> 25 07-27-14 <br /> Jim Medlen Folio No. Room No. : 401 <br /> 21266 Burlington Lane A/R Number Arrival : 07-22-14 <br /> Huntington Beach CA 92646 Group Code Departure : 07-27-14 <br /> United States Company Conf. No. : 64700627 <br /> Membership No. : Rate Code : IMGOV <br /> Invoice No. Page No. : 2 of 2 <br /> Date C Description I Charges I Credits <br /> Total 512.87 <br /> "s <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 /> Holiday Inn Express Hotel&Suites <br /> 508 2nd Ave S. <br /> Kearney,NE 68847 <br /> Telephone: (308)234-8100 Fax: (308)338-0892 <br /> http://ttcdalmvapp3.tetratech.com:8888/mvasvue/ultralite/PrintPreview?eid=5372885:1&etype=MVDOC&parentse... 8/7/2014 <br />