HomeMy WebLinkAbout229654 2/25/2014 CITY OF CARMEL, INDIANA VENDOR: 368004 Page 1 of 1
ONE CIVIC SQUARE ELIZABETH ROYSE CHECK AMOUNT: $5.60
CARMEL, INDIANA 46032 C/O LAW
CHECK NUMBER: 229654
CHECK DATE: 2/25/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1180 4343004 5 . 60 TRAVEL PER DIEMS
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO.101(1986)
MILEAGE, CLAIM... I
O� C(GCM¢,� TO <.tI 2��Q I hOV
r
(GOVERNMENTAL UNIT) _ ON ACCOUNT OF APPROPRIATION NO. !q-300!qFOR I r� V ��r h(jev'o
(OFFICE,BOARD,DEPARTMENT OR INSTITUTION)
DATE FROM TO SPEEDOMETER
READING + AUTO MILEAGE
�q NATURE OF BUSINESS MILES @ ' 5("
s
POINT POINT START FINISH TRAVELED PER MILE
a 114 014 L qJ 610
AUTO LICENSE NO. TOTALS 11 O
+ 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, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after;aliowing all just credits ,
and that no part off the same has been paid.
Date `TI -
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form.
17o'�o0+\-"h OV 5 e That it is duly authenticated as required
by law .
That it is based upon statutory authority.
�C,w 1 l g b That it is apparently correctincorrect
$ 5. b
Disbursing Officer
On Account of Appropriation No.7for
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A.E.BOYCE CO.,INC.MUNCIE,IN 01136