HomeMy WebLinkAbout228967 2/11/2014 "qM CITY OF CARMEL, INDIANA VENDOR: 065950 Page 1 of 1
ONE CIVIC SQUARE DIANA CORDRAY CHECK AMOUNT: $31.36
CARMEL, INDIANA 46032 11843 STONEY BAY CIRCLE
CARMEL IN 46033-9501 CHECK NUMBER: 228967
CHECK DATE: 2/11/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4343004 31 . 36 MILEAGE
Prescribed by State Board of Accounts General Form No. 101 (1955)
• MILEAGE CLAIM ---,
TO DR.
6110
(Governmental� U t) On Account of Appropriation No. for
(Office,Board, Department or Institution)
DATE FROM TO �"
ODOMETER READING" NATURE OF BUSINESS AUTO MILES MILEAGE @ , SW
20 Point Poi t Start Finish TRAVELED PER MILE
FL�L_�/q S 0
:JA- J�4 127as 7 / ,l �
U .
Auto License No. TOTALS
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount clai ed is legally due, after
allowing all just credits, and that no part of the same has been paid.
Date
Claim No. Warrant No. I have examined the within claim and
hereby certify as follows:
IN FAVOR OF
That it is in proper form;
That it is duly authenticated as required
by law;
That it is based upon st tuter_y\thority;
That it is apparentlycorrect
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On Account of Appropriation No._ _for
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