HomeMy WebLinkAbout240311 12/16/14 %'"��� CITY OF CARMEL, INDIANA VENDOR: 359065
® ; ONE CIVIC SQUARE BOB HIGGINS CHECK AMOUNT: $********20.16*
�� �_� CARMEL, INDIANA 46032 16133 HYMERA GREEN CHECK NUMBER: 240311
y��TON�° WESTFIELD IN 46074 CHECK DATE: 12/16/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 20.16 TRAVEL PER DIEMS
Prescribed by Slate Board of Accounts General Form No.101 (1955)
MILEAGE CLAIM
Ctr TO o �fS DR.
In-
(Governmentalnit)
On Account of Appropriation No. for
(Ottice,l3oard,Department or Institution
DATE FROM TO ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE @ ,56
20 Point Point Start Finish TRAVELED PER MILE
/�- /56rev..� _ fel y6
�pB&C fclf�< 4 v
/ t
4GC
Auto License No. TOTALS r� 0
* SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155,Acts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally,due,'after
allowing all just credits, and that no part of the same has been paid.
Date
i
i .
Claim No. Warrant No. I have excanined the within claim and
hereby certify as follows:
IN FAVOR OF
/ That it is in proper form;
That it is duly authenticated as requi
by law;
That it is based upon statutory autho:
That it is apparently correct
incorrect
On Account of Appropriation No. for
Disbursing Officer
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Allowed 20 1. H
I in the sum of$ d ra
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(Board or Commission)
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