HomeMy WebLinkAbout238457 10/21/14 u!.C�q�F
;� CITY OF CARMEL, INDIANA VENDOR: 368794
® i; ONE CIVIC SQUARE APRIL MURRAY CHECK AMOUNT: $"""""*13.44*
r., r CARMEL, INDIANA 46032 C/O LAW CHECK NUMBER: 238457
�btroN c0� CHECK DATE: 10121114
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1180 4343004 13.44 TRAVEL PER DIEMS
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO.101(1986)
MILEAGE CLAIM
TO_�_f
op OA{ry`0-'(GOVERNMENTAL UNIT) z
ON ACCOUNT OF APPROPRIATION NO. 3l � FOR
(OFFICE,BOARD,DEPARTMENT OR INSTITUTION)
DATE FROM TO SPEEDOMETER AUTO MILEAGE
READING + NATURE OF BUSINESS MILES 15'&
c
POINT POINT START FINISH TRAVELED
PER MILE
2LQ
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. 6 `�
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 legally due, after:aliowing all just credits ,
and that no part of the same has been paid.
Date
x:
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form.
—7/Ll )9
That it is duly authenticated as required
1 �� by law
C: .
�V� C � That it is based upon statutory authority.
That it is apparently correct
f incorrect
! Disbursing Officer
On Account of Appropriation No. 3�/Ior
/� o tr a
1 \p nfi ,H �Za U)
a m o -,
H n
N a
ria.. .•F
Allowed , 19 % 5, 0, a
`M : ID
raj I
in the sum of
m
K N•
M A)
M
� a
o
CL a
M p
M a
� a. n
0
o
(Board or Commission) 0 n
a M rt
so-
a
FILED A. w
y M
a ow
th to
�r Ul M
m a �
(Official Title) a
0
'+ O 8
o
0
M
tsGni' tl•
A.F.BOYCE CO.,INC.MUNCIE,IN 01136 Q+