HomeMy WebLinkAbout180903 12/30/2009 CITY OF CARMEL, INDIANA VENDOR: 356305 Page 1 of 1
�f ONE CIVIC SQUARE DARRELL D NORRIS CHECK AMOUNT: $14.30
0 CARMEL, INDIANA 46032 101 2ND AVE SW, #2C
-1, CARMEL IN 46032 CHECK NUMBER: 180903
CHECK DATE: 12/30/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1160 4343004 14.30 TRAVEL PER DIEMS
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
LI c
/-7., MILEAGE CLAIM L49_ ,ec L. X C),
J1f 7 (GOVERNMENTAL UNIT) 1) e x! /40) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTIT _ION)
SATE FROM TO SPEEDOMETER READING AUTO MILEAGE
NATURE OF BUSINESS MILES ®..r 2
POINT POINT I START FINISH TRAVELED 'ER MILE
_I, 34
AUTO LICENSE NO. TOTALS /V b
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway reap. b
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 legs y due, after allowing al /2 j t credits
and that no part f the sa e has been paid.
Date 2 part
p2,2Ji G�i�[�i a
I
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF 4 certify as follows:
bai flUji if t---'C' That it is in proper form.
That it is duly authenticated as required
bylaw.
That it is based upon statutory authority.
i That it is apparently correct
incorrect
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Disbursing Officer
On Account of Appropriation No. for
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A.E. BOYCE CO., INC. MUNCIE, IN 01136
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