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;ii <br /> , r .-,]‘-:‘, <br /> jr c_...- <br /> , ,, ,':-.4 <br /> e y' <br /> i- I ''�f 7 u ail: <br /> 08-06-14 <br /> Jeffery Barna Folio No, : 210755 Cashier No. : 25 Room No. : 423 <br /> United States A/R Number : Arrival : 08-04-14 <br /> Group Code : Departure : 08-06-14 <br /> Company _ Conf. No. : 61110656 <br /> Membership No. : 1 Rate Code : IMGOV <br /> Invoice No. ; Page No. : 1 of 1 <br /> Date I Description Charges I Credits <br /> 08-04-14 'Accommodation 83.00 <br /> 08-04-14 Hotel Occupancy Tax 2% 1-66 <br /> 08-04-14 State Sales Tax 5.5% 4.66 <br /> 08-04-14 County/City Lodging Tax 5% 4.23 <br /> 08-04-14 City Sales Tax 1.5% 1.27 <br /> 08-05-14 `Accommodation 83.00 <br /> 08-05-14 Hotel Occupancy Tax 2% 1.66 <br /> 08-05-14 State Sales Tax 5.5% 4.66 <br /> 08-05-14 County/City Lodging Tax 5% 4.23 <br /> 08-05-14 City Sales Tax 1.5% 1 27 <br /> 08-06-14 Visa XXXXXXXXXXXX2361 189.64 <br /> Total 189.64 189.64 <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 liabtity 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 /> Midtown Holiday Inn <br /> 2503 South Locust Street <br /> Grand Island, NE 68801 <br /> Telephone: (308) 384-1330 Fax: (308)382-4615 <br />