Platte River Implementation Funds Request no. 421

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A Ai 14 9 5 130 ritlatf Inn 08-08-14 Miles Yaw Folio No. : 210898 Cashier No. : 25 Room No. : 424 4545 Wheaton Dr A/R Number : Arrival : 08-04-14 Fort Collins CO 80525 Group Code : Departure : 08-08-14 United States Company Conf. No. : 61113247 Membership No. : PC 149340463 Rate Code : IMGOV Invoice No. • Page No. : 1 of 2 Date Description Charges Credits 08-04-14 *Accommodation 83.00 08-04-14 Hotel Occupancy Tax 2% 1.66 08-04-14 State Sales Tax 5.5% 4.66 08-04-14 County/City Lodging Tax 5% 4.23 08-04-14 City Sales Tax 1.5% 1.27 08-05-14 *Accommodation 83.00 08-05-14 Hotel Occupancy Tax 2% 1.66 08-05-14 State Sales Tax 5.5% 4.66 08-05-14 County/City Lodging Tax 5% 4.23 08-05-14 City Sales Tax 1.5% 1.27 08-06-14 *Accommodation 83.00 08-06-14 Hotel Occupancy Tax 2% 1.66 08-06-14 State Sales Tax 5.5% 4.66 08-06-14 County/City Lodging Tax 5% 4.23 08-06-14 City Sales Tax 1.5% 1.27 08-07-14 *Accommodation 83.00 08-07-14 Hotel Occupancy Tax 2% 1.66 08-07-14 State Sales Tax 5.5% 4.66 08-07-14 County/City Lodging Tax 5% 4.23 08-07-14 City Sales Tax 1.5% 1.27 08-08-14 American Express XXXXXXXXXXX2004 379.28 gYod 33,200 A90441-.3Z \-5 72g Midtown Holiday Inn 2503 South Locust Street Grand Island, NE 68801 Telephone: (308)384-1330 Fax: (308)382-4615