182994 03/03/2010 CITY OF CARMEL, INDIANA VENDOR: 080501 Page 1 of 1
ONE CIVIC SQUARE CINDY SHEEKS
CARMEL, INDIANA 46032 13791 LAREDO DRIVE CHECK AMOUNT: $12.02
CARMEL IN 46032 CHECK NUMBER: 182994
CHECK DATE: 3/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4343004 12.02 CTAR TRAINING
Prescribed by State Board of Accounts General Form No. 101 (1955)
MILEAGE CLAIM bA TO J�w DR.
(Government I U
it)
On Account of Appropriation No. 3 UU` -'f for /)��i YLp ��4_
(OffV,Board Departmen or Institution
DATE FROM TO ODOMETER READING' NATURE OF BUSINESS AUTO MILES MILEAGE
201 Point Point Start Finish TRAVELED PER MILE
L
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.
Date
Claim No. Warrant No. I have examined the within claim and
hereby certify as follows:
IN FAVOR OF
That it is in proper form;
That it is duly authenticated as required
by law;
That it is based upon statutory authority;
I That it is apparently correct
incorrect
On Account of Ap ropriation No for
WA/01 I Disbursing Officer
C �3
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