HomeMy WebLinkAboutResolution #605~ ~ YY ./
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MUNICIPAL REQUEST FQR
OF MOTOR FUEL TA
To the: STATE OF ILLINOIS
DEPARTMENT OF PUBLIC WORKS AND BUILDINGS
DIVISION OF HIGHWAYS
BUREAU OF LOCAL ROADS AND STREET5
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EXPENOtTURE
X FUNOS
Municipality_ Camtaa
Section Ceetract HainC~uanca 1972 A
I hereby request authorization to expend MFT funds as itemized below:
CONSTRUCTION COSTS .............................................. .
ENGINEERING COSTS ................................................. $ 666.89
RIGHT-OF-WAY COSTS (As per itemization on reverse side) .................... .
MAINTENANCE COSTS (Period from to ) ... • . • • • • • • • • •
IMRF OR SOCIAL SECURITY ..................................... .. .
TOTAL FUNDS REQUIRED ................. $ 66b•89
Date ~~ ~ J , 19 ~~
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Signed by ~ ~>..r:~ir G~
' Ctcy Clsrk ,%~
~tle o ~c
(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 $
*!f contract section, show contract costs instead of estimated cost.
RESOLUTIONS APPROVED , 19.
,19
Form BLR 471 (Rev. 10-69)