HomeMy WebLinkAbout183943 03/29/2010 CITY OF CARMEL, INDIANA VENDOR: 364028 Page 1 of 1
ONE CIVIC SQUARE WESLEY SMITH JR
CARMEL, INDIANA 46032 5840 E 256TH ST CHECK AMOUNT: $76.50
ARCADIA IN 46030
o CHECK NUMBER: 183943
CHECK DATE: 3/29/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 76.50 TRAVEL PER DIEMS
Prescribed by State Board of Accounts General Form No. 161 (1955)
L f MILEAGE CLAIM
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TO y, tl� �i� I DR.
(Governmental nit)
On Account of Appropriation No. for
Office, Board, Department or Institution)
DATE FROM TO ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE 145 C)
20 Point Point Start Finish TRAVELED PER MILE
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Auto License No.I TOTALS Q
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. I r
Dat
Claim No, Warrant No. I have exaiznined the within claim and
hereby certify as follows:
IN FAVOR OF
That it is in proper farm;
That it is duly authenticated as requi
by law;
That it is based upon statutory autho
That it is apparently correct
3 incorrect
On Account of Appropriation No. for
wt. Disbursing Officer
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