187247 07/07/2010 1
CITY OF CARMEL, INDIANA VENDOR: 363569 Page 1 of 1
ONE CIVIC SQUARE MICHAEL CALVERT CHECK AMOUNT: $25.00
CARMEL, INDIANA 46032 C/O BROOKSHIRE GOLF COURSE
CHECK NUMBER: 187247
CHECK DATE: 717/2010
D EPARTMENT ACCOUNT P O NUMBER INVOICE NUM AMOUNT DESCRIPTION
1207 4343004 JUNE MILEAGE 25.00 MILEAGE
l!
Claim No, Warrant No. I have examiners •the within claim and hereby
IN FAVOR OF cprtiiy as follows:
c That it is in proper form
V T"nat. it is -duly authentic -ated as required
by lava.
That it is based upon statutory authority.
That it is apparently 4 correct
incorrect
On Account of Appropriation No. for Disbursing O€ is -er
ID
CD'
G p Q [D
Allowed 19 0 Q
L-1 the sum of
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tc� y. 0
N
(Board or `C- 6nifnission) m R
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FILED .o a, n
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(Official `ride) a' R G
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A. C, ■Of CS CD,. YYN CIl. lKD. 06]71
lr�ib.d by 3t-i. Board of Aoo.=t*,
:ea aal Faun No. !OS [I q!
MILEAGE CLAIM
(GOVERNMENTAL UNITI TO J
`T
ON ACCOUNT OF APPROPRIATION NO. -FO
(OFFICE. SCARD. DEPARTMENT OR INSTITUTION)
DATE FROM TO SPEEDOMETER AUTO MILE F�
READING+ MILES �p U
DoINT POINT STA I r NATURE_ OF BUSINESS TRAVELED PER MILE=
2 o IN 5
W� C!- N G� U Z'�S
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k
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AUTO LICENSE NO. TO TALS
+SPEEDOMETER READING colurins are to he 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 al -Haunt c l a i me d is legally due. after allowing 11 Just Creel
and that no part of the same has been paid.
Date /d'/
►rr=ib.d bf 3ta!• Board of At
t .,w —a. r �eaud Form No. 101 Cl t:U
DL `f J MILEAGE CLAM
it (Gov r L RNMENTAL UNIT) TQ ��L DR
ON ACCOUNT OF APPROPRIATION N0. FO
(OFFICE. BOARD. DEPARTMENT OR INSTETUTION)
DATE FROM SPEEDOMETER i UTO MILEAGE
TO
READING+ I L� T-
ATURE OF BUSINESS AVEL ED PER MILE= POINT POINT START 711415~
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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 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 legally due. aher aIlowing.all just creel
and that no part of the same has been paid.
Date
Claim No. Warrant No. I have examined -the widen -claim :and. hereby
IN FAVOR O certify as foilows:
r! That it is in proper 'form
Y Trat it is duly authenticated. as required
by law.
That it is based upon statutory aut!'icrity.
That it is apparently t correct
incorrect
On Account of Appropriation No. for D isbursing Officer
w
Q R. n
Allowed 19 c�
in the sum of
(Board or Commission) k R
fl O O
FILED n
n
(Official Title)
a
o CD
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A. C. BCYCf CO.. IICNCIL INC. Ci'i]] n C?