Act 195 Interest Arbitration Invoice {PLRB-52}

ACT 195 INTEREST ARBITRATION INVOICE002 VENDOR INFORMATION LOCATION CODE: 12PLRB002 Name Vendor ID Address Invoice Number City State Zip Telephone Signature Date CASE INFORMATION Case Number Employer Employe Organization SERVICES PROVIDED002 Hearing date(s): Number of days: $ Preparation, research, writing date(s): Number of days: $ EXPENSES Mileage: miles @ $/mile $ Parking and tolls $ Lodging $ Subsistence $ Postage/Mailing $ Miscellaneous (please explain): $ TOTAL: $ 002PLEASE SEND YOUR INVOICE TO THIS ADDRESS: Pennsylvania Labor Relations Board 12PLRB PO Box 69181 Harrisburg, PA 17106 Pennsylvania Labor Relations Board 651 Boas Street, Room 418 | Harrisburg, PA 17121-0750 | 717.787.1091 | F 717.783.2974 | www.dli.pa.gov Auxiliary aids and services are available upon request to individuals with disabilities. Equal Opportunity Employer/Program American LegalNet, Inc. www.FormsWorkFlow.com