HomeMy WebLinkAbout323053 03/21/18 (�D'
CITY OF CARMEL, INDIANA VENDOR: 359065ONE CIVIC SQUARE BOB HIGGINS CHECK AMOUNT: $********33.78`CARMEL, INDIANA 46032 1895 WEST 211TH CHECK NUMBER: 323053
SHESHERIDAN IN 46069 CHECK DATE: 03/21/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 MILEAGE 33.78 TRAVEL PER DIEMS
;r
r '
Prescribed by Slate Board of Accounts
MILEAGE CLAIM
&�rcl JJ
�---
(Governmeenta nit) /
On Account of Appropriation No. for
(Office,Board,Department or Institution
DATE FROM TO ODOMETER READING* NATURE OF BUSINESS AUTO MILES
Point Point Start Finish TRAVELED
' oU AllI U _d[J�a�
3 ) ` 2
3 o 5 C� ' t a j-1C i1 txc l u,
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.
I
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,iafter
allowing all just credits, and that no part of the same has been paid.
Date —1,=5 d
1 i
l II
r Claim No. Warrant No. ; I have examined the within claim and
hereby certify as follows:
� IN FAVOR OF
That it is in proper form;
'ff � That it is duly authenticated as requi:
I t by law;
f -
That it is based upon statutory author
That it is apparently correct
$ 3 incorrect
On Account of Appropriation No. 0 for
L 341�� Disbursing Officer
{ O 'ti
Allowed ,20IS
in the sum of$ —3 o •
N
bPD,
o (RD
(Board or commission) IC
FILED o
En'
R
O
i
m
' (OfIlciai Title) ,
II
-----...--...... O