HomeMy WebLinkAbout235075 07/22/14 �%'�'q,,f� CITY OF CARMEL, INDIANA VENDOR: 065950
1, CHECKAMOUNT: $********30.24*
ONE CIVIC SQUARE DIANA CORDRAY
�_�; CARMEL, INDIANA 46032 11843 STONEY BAY CIRCLE CHECK NUMBER: 235075
,��TON�, CARMEL IN 46033-9501 CHECK DATE: 07/22/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4343004 30.24 MILEAGE
General Form No.101 1955
Prescribed by State Board of Accounts � ( )
MILEAGE CLAIM
L/ 0�2 6"eJ TO —DR.
G ernmental Unit)
On Account of Appropriation No. for
(Office, Board, Department or Institution
n f/ ATE FROM TO ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE
/(
20 / Point Point Stark Finish TRAVELED PER MILE_.
kVV
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 jus, and that no part of the same has been paid. j
Date / ��l
Clam 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;
4
That it is based upon statutory authority;
�' $ Q That it is apparentlycorrect
{incorrect
+ On Account of Appropriation No. for
� f Disbursing Officer
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Allowed 20 (D o
in the sum of$ o
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