HomeMy WebLinkAbout185173 05/11/2010 CITY OF CARMEL, INDIANA VENDOR: 363569 Page 1 of 1
ONE CIVIC SQUARE MICHAEL CALVERT
CARMEL, INDIANA 46032 C/O BROOKSHIRE GOLF COURSE CHECK AMOUNT: $5.00
CHECK NUMBER: 185173
CHECK DATE: 5/11/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 5.00 TRAVEL PER DIEMS
►re+aribed by State Board of Aao�ta. „eaeral Form No. 101 (U*u
MILEAGE CLAIM
(GOVERNMENTAL UNIT) TO G[1 1 4- r DR.
ON ACCOUNT OF APPROPRIATION N0. FO
(OFFICE. BOARO, DEPARTMENT OR INSTITUTION)
SPEEDOMETER AUTO MILEAGE
DATE FROM TO READING+ MILES @Q S�
2- O POINT POINT STA§T FINISH NATURE OF BUSINESS I TRAVELED PER MILE
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AUTO LICENSE NO. TOTALS
+SPEEDOMETER READING columns are. to be used only when distance between points cannot be determined by fixed nuleage 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 legally due, after allowing all just cr
and that no part of the same has been paid.
Date
Claim No. Warrant No. I have examined -the within -claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form.
t II That. it is -duly authentic4ated as required
I by law.
That it is based upon statutory authority.
That it is apparently t correct
incorrect
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