252308 12/08/15 0J^/ �� CITY OF CARMEL, INDIANA VENDOR: 120950
�• ONE CIVIC SQUARE DOUGLAS HANEY CHECK AMOUNT: S"'***'**l.15*
�\ >�� CARMEL, INDIANA 46032 C/O DEPT OF LAW CHECK NUMBER: 252308
M�«Uti�, C/O DEPT OF LAW CHECK DATE: 12/08/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1180 4343004 1.15 TRAVEL PER DIEMS
' ascribed by State Board of Accounts MM �p���aa m�aepp ��qq ,I General Form No.101(1955)
9WEN�t�A�@�1� h,�i4m�'G1f� �
City of Carmel, Indiana TO O.0 DR.
(Governmental Unit)
Department of Law - 1180 On Account of Appropriation No. 434-3004 for Mileage
Office,Board,Department or Institution)
i
DATE FROM TO -
ODOMETER READING* NATURE OF BUSINESS I AUTO MILES MILEAGE @
20 Point Point Start Finish l TRAVELED PER MILE
2I 15 NiscossiO 5
Auto License No. TOTALS 5
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
ursuant 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
lowing all just credits, and that no part of the same has been paid.
ate
`Claim NoWarrant No. I have examined the within claim and
.
hereby certify as follows:
IN FAVOR OF
�0 alp 0, That it is in proper form;��.�.�
That it is duly authenticated as required
by law;
That it is based upon statutory authority;
That it correct
is apparently
incorrect
On Account of Appropriation No.4343004 for
Disbursing Officer
Depart-mast of Law — 1180
Allowed .20
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