HomeMy WebLinkAbout248945 08/26/15 ' *f CITY OF CARMEL, INDIANA VENDOR: 368794
® 31 ONE CIVIC SQUARE APRIL MURRAY CHECK AMOUNT: 6**......19.55*
:. ,ra CARMEL, INDIANA 46032 C/O LAW CHECK NUMBER: 248945
''"�roN�a CHECK DATE: 08/26/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1180 4343004 MILEAGE 19.55 TRAVEL PER DIEMS
Prescribed by State Board of Accounts General Form No.101(1955)
MOLEAGE CLAIM
City of Carmel, Indiana TO DR.
(Governmental Unit)
Department of Law - 1180 On Account of Appropriation No. 434-3004 for Mileage
Office,Board,Department or Institution)
DATE FROM TO ODOMETER READING" NATURE OF BUSINESS AUTO MILESFm
LEAGE @ �
20 Point Point Start Finish TRAVELED PER MILE
VIN b 5
Auto License No. TOTALS S5
k 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
Clcam No, Warrant No. I have examined the within claim and
hereby certify as follows:
IN FAVOR OF
That it is in proper form;
l That it is duly authenticated as required
40Y'�) by law;
That it is based upon statutory authority;
That it is apparently correct
$ I q 55 incorrect
On Account of Appropriation No.4 3 4 3 0 0 4 for
Disbursing Officer
Department of Law - 1180
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