HomeMy WebLinkAbout241336 01/22/15 C4N .
CITY OF CARMEL, INDIANA VENDOR: 368794
i, ONE CIVIC SQUARE APRIL MURRAY CHECK AMOUNT: S""'""13.44'
as CARMEL, INDIANA 46032 C/O LAW CHECK NUMBER: 241336
',Nero„ CHECK DATE: , 01/22/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1180 4343004 13.44 TRAVEL PER DIEMS
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FOAM NO.101(1986)
r n,, MILEAGE. CLAIM
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11
(GOV RNMENTAL UNIT)
��^n D(' ON ACCOUNT OF APPROPRL4TION Mn �U FOR �(G Vt I �Q( �j P.M
(OFFICE,BOARD DEPARTMENT OR INSTITUTIONS (J
DATE FROM TO SPEEDOMETER AUTO MILE,AGE
READING + NATURE OF BUSINESS• MILES @� 2
POINT POINT START FINISH TRAVELED PER MILE
15 )afl l 'iv Nc�b�elie mobus4 1300,9 1 07 O e QG in w
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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, 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.
Date
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form.
That it is duly authenticated as required
by law .
That it is based upon statutory authority.
That it is apparently correct
incorrect
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A.E.BOYCE CO.,INC.MUNCIE,IN 0113,6a