HomeMy WebLinkAbout184225 04/14/2010 CITY OF CARMEL, INDIANA VENDOR: 361017 Page 1 of 1
ONE CIVIC SQUARE JENNY CHASTAIN CHECK AMOUNT: $20.50
f CARMEL, INDIANA 46032 511 SECOND AVE NE
rc CARMEL IN 46032
CHECK NUMBER: 184225
CHECK DATE: 4/14/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1160 4343004 20.50 TRAVEL PER DIEMS
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM ,l? S e n Jenn&4 10A
(GO ENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
DATE FROM TO SPEEDOMETER AUTO MILEAGE
READING MILES
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MILE
c .3
D o
Q
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, I hereby certify that the foregoing account is just and correct, that the amount claimed is legall due, after allowing all just credits
and that no part of the same has been paid.
Date /2—
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form.
That it is duly authenticated as required
by law
That it is based upon statutory authority.
That it is apparently correct
incorrect
Disbursing Officer
On Account of Appropriation No. for
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A .I. BOYCI CO., INC. HUNCQ, By 01136