HomeMy WebLinkAbout229696 2/25/2014 CITY OF CARMEL, INDIANA VENDOR: 366267 Page 1 of 1
ONE CIVIC SQUARE ASHLEY ULBRICHT
0 CHECK AMOUNT: $33.60
CARMEL, INDIANA 46032 433 AUTUMN DRIVE
CARMEL IN 46032 CHECK NUMBER: 229696
CHECK DATE: 2/25/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1180 4343004 33 . 60 TRAVEL PER DIEMS
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO.101(1986)
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MILEAGE CLAIM
(GOVERNMENTAL UNIT)
" r l ON ACCOUNT OF APPROPRIATION NO. 3 D0 FOR
��J-Yti(�'IrYIfL►'1'�` Com' F. G. �
(OFFICE,BOARD,DEPARTMENT OR INSTITUTIOR�
AUTO MILEAGE�
'READING + NATURE OF BUSINESS MILES C�
V L POINT POINT START FINISH TRAVELED
DATE FROM TO SPEEDOMETER
PER MILE
1 a ` 0?(0 4,5 OC) g4of5w - v ( tD &-m'jnor 6SaValifiaA . 6,4) 3 D iFro
cj- D a 4p,5(v 0 r'10 vAnn
AUTO LICENSE NO. TOTALS 33 D
+ 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 le ally due, after allowing all just credits ,
end that no part of the same has been paid.
DateL��UCi(�
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
l ll That it is in proper form.
That it is duly authenticated as required
by law .
That it is based upon statutory authority.
(�-(YL,t?(l'f" D G•V's That it is apparently correctincorrect
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Disbursing Officer
On Account of Appropriation No. 3200for
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