HomeMy WebLinkAbout189707 09/14/2010 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:
CHECK NUMBER: 1117 189707
CHECK DATE: 9/14/20'-
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 6.50 MILEAGE
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Pt,—ib.d bT 8(m* Ho d o: A—= tl. ..ea acaE Form No. 101 Uk]t
f MILEAGE CLAIM
(OVERMENTAL UNIT) TO DR.
G N
ON ACCOUNT OF APPROPRIATION N0. FO
(OFFICE. 90AF(D. DEPARTMENT OR INSTITUTION)
SPEEDOMETER 1 AUTO �MILE DATE FROM AGE
TO READING+ I MILES
NATURE OF BUSINESS TRAVELED PER MILE
Zo /D ?OINT POINT START FkN151-'
1 4 I Rllrf� I R) 70 11
r 2r�u A- L.� I Z 7 Z
F-- W eZ I d
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AUTO LICENSE NO. TOTALS
+SPEED41MET 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 part of the same has been paid.
—Dote
Claim No. Warrant No. I have examined •the wi -t La,cla:= and herelDy
IN FAVOR OF certify as follows:
That it is in proper form,
That it is -diily authenticated as required
by taw.
That it is based upon statutory authority.
That it is apparently correct
incorrect
On Account of Appropriationi No. -for !)is wising Of leer
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