HomeMy WebLinkAboutResoluiton #3690-AIllinois Department
of Transportation
For District Use Only
Transaction Number
Date
Checked by
13690 A
Request for Expenditure/Authorization
of Motor Fuel Tax Funds
Municipality Canton
Countv Fulton
Rd. District
Section 01-00089-00-EG
I hereby request authorization to expend Motor Fuel Tax Funds as indicated below.
Purpose Amount
Contract Construction ...............................................................................................................................
Day Labor Construction ...........................................................................................................................
Right-of--Way (Itemized On Reverse Side) ................................................................................................
Engineering ....................................................................................................................:.......................... 26,419.24
Maintenance Engineering .........................................................................................................................
Engineering Investigations ........................................................................................................................
Other Category ..........................................................................................................................................
Obligation Retirement ...............................................................................................................................
Maintenance ..............................................................................................................................................
Co. Eng./Supt. Salary ~ Expenses (Period from to )
IMRF or Social Security ............................................................................................................................
Interest ...................................
...................................
...................................
Total $ 26,419.24
Comments Authorization for both the design and Date ~ 2004
construction supervision for construction section Signed by
01-00089-01-RS (LAPP FY03). ~
(Title ~ Official)
BLR 4201 (Rev. 6/2000)
Page 1 of 2
Illinois Department
of Transportation
For District Use Only
Transaction Number
Date
Checked by
Request for Expenditure/Authorization
of Motor Fuel Tax Funds
Municipality Canton
Countv Fulton
Rd. District
Section
01-00089-00-EG
I hereby request authorization to expend Motor Fuel Tax Funds as indicated below.
Purpose Amount
Contract Construction ...............................................................................................................................
Day Labor Construction ...........................................................................................................................
Right-of-Way (Itemized On Reverse Side) ................................................................................................
Engineering ............................................................................................................................................... 26,419.24
Maintenance Engineering .........................................................................................................................
Engineering Investigations ........................................................................................................................
Other Category ..........................................................................................................................................
Obligation Retirement ...............................................................................................................................
Maintenance ..............................................................................................................................................
Co. Eng./Supt. Salary & Expenses (Period from to )
IMRF or Social Security ............................................................................................................................
Interest
Total $ 26,419.24
Comments Authorization for both the design and
construction supervision for construction section
01-00089-01-RS (LAPP FY03).
Date ~ /~ (~ ~ 2004
Signed by „`
/~ ~a~
(Title of Offi ial)
BLR 4201 (Rev. 6/2000)
Page 1 of 2
Illinois Department
of Transportation
For District Use Only
Transaction Number
Date
Checked by
Request for Expenditure/Authorization
of Motor Fuel Tax Funds
Municipality Canton
County Fulton
Rd. District
Section 01-00089-00-EG
I hereby request authorization to expend Motor Fuel Tax Funds as indicated below.
Purpose Amount
Contract Construction ...............................................................................................................................
Day Labor Construction ...........................................................................................................................
Right-of-Way (Itemized On Reverse Side) ................................................................................................
Engineering ....................................................................................................................:.......................... 26,419.24
Maintenance Engineering .........................................................................................................................
Engineering Investigations ........................................................................................................................
Other Category ..........................................................................................................................................
Obligation Retirement ...............................................................................................................................
Maintenance ..............................................................................................................................................
Co. Eng./Supt. Salary & Expenses (Period from to )
IMRF or Social Security ............................................................................................................................
Interest
...................................
Total $ 26,419.24
Comments Authorization for both the design and
construction supervision for construction section
01-00089-01-RS (LAPP FY03).
Date ~ ~ y- cr N 2004
Signed by
~J~ ~ a~
(Title of Official)
BLR 4201 (Rev. 6/2000)
Page 1 of 2
f
Illinois Department
of Transportation
For District Use Only
Transaction Number
Date
Checked by
Request for Expenditure/Authorization
of Motor Fuel Tax Funds
Municipality Canton
Countv Fulton
Rd. District
Section 01-00089-00-EG
I hereby request authorization to expend Motor Fuel Tax Funds as indicated below.
Purpose
Contract Construction ..................................................................................................
Day Labor Construction ..............................................................................................
Right-of-Way (Itemized On Reverse Side) ...................................................................
Engineering ..................................................................................................................
Maintenance Engineering ............................................................................................
Engineering Investigations
Amount
........................
........................
........................ 26,419.24
........................
Other Category ..........................................................................................................................................
Obligation Retirement ...............................................................................................................................
Maintenance ..............................................................................................................................................
Co. Eng./Supt. Salary & Expenses (Period from to )
IMRF or Social Security ............................................................................................................................
Interest
Comments Authorization for both the design and
construction supervision for construction section
01-00089-01-RS (LAPP FY03).
Total $ 26,419.24
Date ~' - ~ ~_ G y , 2004
Signed by ~
~~ ~
(Title of Officia
BLR 4201 (Rev. 6/2000)
Page 1 of 2