HomeMy WebLinkAbout188262 08/03/2010 CITY OF CARMEL, INDIANA VENDOR: 363569 Page 1 of 1
4 ONE CIVIC SQUARE MICHAEL CALVERT
CHECK AMOUNT: $4.00
CARMEL, INDIANA 46032 C/O BROOKSHIRE GOLF COURSE
CHECK NUMBER: 188262
CHECK DATE: 8/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 4.00 TRAVEL PER DIEMS
hp=ibrd by Std• B O4rd of Accatmts.
.^.m.t ai Form No. 101 Cl be
MILEAGE
(GOVERNMENTAL. UNIT) TO CLAIM DR.
ON ACCOUNT OF APPROPRIATION NO. FO
(OFFICE. BOARD, DEPARTMENT OR INSTITUTION)
DATE FROM TO SPEEDOMETER I AUTO MILEAGE
READING+ MILES
POINT NATURE OF BUSINESS I TRAVELED PER MELE
FO NT START FINISH
D/U J 2 S I
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AUTO L:ICEN _E 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. after allowing all just creel
and that no p of the same has been paid.
aQte I r
Claim No. Warrant No. I have examined -the withal -claim and.herebY
IN FAVOR OF certify cis follows:
That it is in proper form
i I L I That. it is -duly authenticated as required
by law.
That
it is based. upon statutory authority
That it is apparently t correct
l
r incorrect
On Account of Appropriation No. for Leis ursing Df icer
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in the sum of $a Q
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