HomeMy WebLinkAboutResolution #606~~ ~~
7227-02
MUNICIPAL. REQUEST FOR EXPENDITURE
OF MOTOR FUEL .TAX FUNDS
Municipality CsnCe>~
To the: STATE OF ILLINOIS - Section Ca~-tract 1°I~tix~t~anca 1972
DEPARTMENT OF PUBLIC WORKS AND BUILDINGS
DIVISION OF HIGHWAYS
BUREAU OF LOCAL ROADS AND STREETS
I hereby request authorization to expend MFT funds as itemized below:
CONSTRUCTION COSTS ............................................... $
ENGINEERING COSTS ................................................. ~ 514.51
RIGHT-OF-WAY COSTS (As per itemization on reverse side) .................... .
MAINTENANCE COSTS (Period from to ) ............... .
IMRF OR SOCIAL SECURITY ........................................... $
TOTAL FUNDS REQUIRED ............:.... $ 810.51
r
Date ~? f`y..~,.~_ ~.,2 ~ , 19 72
Signed by_ ~ ;:.~ f ~..-,,~ .
~C1ty Clark
(Tit- eIe pf~`~#cia15~~J
(Submit ONE copy to the District Engineer)
.. ____..
(Space below for District Engineer only)
RESOLUTIONS PASSED , 19_
19._
TOTAL MONEY APPROPRIATED $
ESTIMATED COST-Const. * $
(plus additions Engr.
minus deductions) R.O.W.
Maint.
TOTAL $
AUTHORIZED TO DATE-Constr. $-
Engr..
R.O.W.
Maint.
TOTAL $
BALANCE IN APPROPRIATION $
*If contract section, show contract costs instead of estimated cost.
RESOLUTIONS APPROVED , 19.
19-~
Form BLR 471 (Rev. 10-69)