HomeMy WebLinkAbout232900 05/21/14 ��_Coq
u% "€� CITY OF CARMEL, INDIANA VENDOR: 080501
j; ® 31 ONE CIVIC SQUARE CINDY SHEEKS CHECK AMOUNT: $********1 1.20*
,_� CARMEL, INDIANA 46032 14382 WHISPER WIND DR CHECK NUMBER: 232900
'+rpTON�a CARMEL IN 46032 CHECK DATE: 05/21/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4343004 11.20 MILEAGE
Prescribed by State Board of Accounts General Form No.101 (1955)
MILEAGE CLAIM
ig, lid TO V" �1 DR.
(Governmental Unit)
ILMM , On Account of Appropriation No. foriP,f
4055
(Office,Board,Department or Institution)
DATE FROM TO ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE @ �
20 Point Point Start Finish
j TRAVELED PER MILE
f
fto C&L Too(L
S S �
i
i
l
i
Auto License No. TOTALS
1!
*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 legally4ue, er
allowing all just credits, and that no part of the same has been paid.
Date 2� 14
I
it
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 statuto authority;
y correct
,
$ � � That it is apparently
un eat
On Account of Appropriation No.��for
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Allowed 20 (D � o
in the sum of$
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