Request for Expenditure/Authorization of Motor Fuel Tax Funds For District Use Only Transaction Number Municipality County Date Rd. District Checked by Section 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 Maintenance Engineering Engineering Investigations Other Category Obligation Retirement Maintenance Co. Eng./Supt. Salary & (Period from ) to Expenses IMRF or Social Security Total $ Comments Approved Date , Date Signed by Department of Transportation Title of Official Regional Engineer
Request for Expenditure/Authorization of Motor Fuel Tax Funds For District Use Only Transaction Number Municipality County Date Rd. District Checked by Section 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 Maintenance Engineering Engineering Investigations Other Category Obligation Retirement Maintenance Co. Eng./Supt. Salary & Expenses (Period from to ) IMRF or Social Security Total $ Comments Date , Approved Signed by Date Department of Transportation Title of Official Regional Engineer