HomeMy WebLinkAbout185389 05/11/2010 CITY OF CARMEL, INDIANA VENDOR: 354940 Page 1 of 1
ONE CIVIC SQUARE THOMAS PERKINS
CHECK AMOUNT: $38.50
CARMEL, INDIANA 46032 14150 EQUINE COURT
WESTFIELD IN 46074 CHECK NUMBER: 185389
CHECK DATE: 5/11/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1180 4343004 38.50 TRAVEL PER DIEMS
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PRESCRIBED BY STATE HOARD OF ACCOUNTS
GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
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RNM L UNIT
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ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTME R INSTITUTION)
DATE FROM TO SPEEDOMETER AUTO MILEAGE
READING MILES
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
i PER MILE
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AUTO LICENSE NO. TOTALS g�
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. CJ
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 credits
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 certify as follows:
r 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
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A.E. ROYCE CO., INC. MUNCIN, IN 01136
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