HomeMy WebLinkAbout241098 1 /13/2015 *° CITY OF CARMEL, INDIANA VENDOR: 368794
`/ `+. CHECK AMOUNT: $********12.88*
.� ® �� ONE CIVIC SQUARE APRIL MURRAY
r, ?�; CARMEL, INDIANA 46032 C/O LAW CHECK NUMBER: 241098
"'"„TON�' CHECK DATE: 01/13/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1180 4343004 12.88 TRAVEL PER DIEMS
PRESCRIBED BY STATE HOARD OF ACCOUNTS ARTY���� �p�Y}� nn ( GENERAL FORM NO.101(1986)
SYlll, h�To11.
0,�A\4 0-F e- `
(GOVERN UNIT) 1 Y a
��t7a� I��+ OT �� l g� ON ACCOUNT OF APPROPRIATION NO.q3-4 FOR E r
(OFFICE,BOARD,DEPARTMENT OR INSTITUTION)
DATE FROM TO SPEEDING TER I AUTO MILEAGE
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED @ D o� Q
PER MILE
2 t (arnw . I M tD I In Ws 0 11 R N I 102 5$
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AUTO LICENSE NO. TOTALS a g
+ 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,I 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. I
Date
i
Claim No. Warrant No. I have`examined!the within claim and hereby
IN FAVOR OF certify as follows:
i
� � ! That it is in proper form.
That it is duly authenticated as required
by law .
That it is based upon statutory authority.
correct
f� That it is apparently { incorrect
j Disbursing Officer
On Account of Appropriation No or
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A.E.BOYCE CO.,INC.MUNCIE,IN 01136 �•