HomeMy WebLinkAbout243482 03/24/15 CITY OF CARMEL, INDIANA VENDOR: 065950
;s ONE CIVIC SQUARE DIANA CORDRAY CHECK AMOUNT: $********20.40*
CARMEL, INDIANA 46032 11843 STONEY BAY CIRCLE CHECK NUMBER: 243482
�+ry�roN.• CARMEL IN 46033-9501 CHECK DATE:; 03/24/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4343004 18.40 MILEAGE
1701 4343004 2.00 PARKING
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Prescribed by State Board of Accounts � General Form No.101 (1955)
MILEAGE CLAIM
rzwhd ` TO _ L 4d !ilJ, DR.
(Governmental Unit)
On Account of Appropriation No. for
(Office,Board, Department or Institution)
DATE - FROM TO ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE @ ✓— y
201 S Point Point Start Finish TRAVELED PER—MILE
I ,
AM ,
I
I
1
f
I
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.
II
Date +».
( Clcdm No. Warrant No. I haveexamined the within claim and
I hereby certify as follows:
IN F4YOR OF
^ i That it is in proper form;
( That it is duly authenticated as required
Jby law;
IThat it is based upon statutory authority;
Gl i That it is apparently {correct-
incorrect
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-On.-Account ofp�rJopriation/No. for
Disbursing Officer
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