HomeMy WebLinkAbout230797 04/02/14 o;... CITY OF CARMEL, INDIANA VENDOR: 360469
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ONE CIVIC SQUARE CONNIE MURPHY CHECK AMOUNT: $*****...14.22
CARMEL, INDIANA 46032 9 HENSEL CT CHECK NUMBER: 230797
".y,�roN.�o.r CARMEL IN 46033 CHECK DATE: 04/02/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4343004 14.22 MILEAGE
Prescribed by State Board of Accounts General Form No.101 (1955)
MILEAGE CLAIM
0 TO ��� �' DR.
�(Genmen al Unit)
1
On Account of Appropriation No. � for10-11id
Office, Board, Department or Institution)
DATE FROM TO
ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE
20 roint oint Start ; Finish TRAVELED PER MILE
T i Yv
Auto License No. TOTALS
* SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after
allowing all just credits, anjd th t no part of the same has been paid.
Date I( —/
Claim No. Warrant No. I have examined the within claim and
hereby certify as follows:
IN FAVOR OF
That it is in proper form;
pV That it is duly authenticated as required
by law;
That it is based upon statutory authority;
f � That it is apparently$ ppincorrect
OA ount of Appropriation No. for
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