HomeMy WebLinkAbout231222 09/18/14 CITY OF CARMEL, INDIANA VENDOR: 355377
`\. CHECK AMOUNT: S"""'""«13.44"
ONE CIVIC SQUARE LOIS CRAIG
?� CARMEL, INDIANA 46032 10680 MORRISTOWN COURT CHECK NUMBER: 237222
CARMEL IN 46032 CHECK DATE: 09/18/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 43430"04 13.44 TRAVEL PER DIEMS
Prescribed by State Board of Accounts
General Form No.101 (1955)
MILEAGE CLAIM
TO L 1 .(� �- DR.
(Governmental Un
02 On Account of Appropriation No._q�"/ for
(Office,Boar , ep rtment or Institution)
DATE FROM TO
ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE @_ ,<;Z
20 Point Point Start Finish TRAVELED PER MILE
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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, and that no part of the same has been paid.
Date
i
C1Com No. Warrant No. I have examined the within claim and
hereby certify as follows:
IN FAVOR OFA 1 _
n That it is in proper form;
(, That it is duly authenticated as required
by law;
That it is based upon statutory authority;
correct
$ I�f That it is apparently I incorrect
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On Account of Appropriation No. for
101O E (4 - Disbursing Officer
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Allowed 20 (D o
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