HomeMy WebLinkAbout190425 09/29/2010 CITY OF CARMEL, INDIANA VENDOR: 354940 Page 1 of 1
ONE CIVIC SQUARE THOMAS PERKINS
CARMEL, INDIANA 46032 14150 EQUINE COURT CHECK AMOUNT: $22.00
WESTFIELDIN 46074 CHECK NUMBER: 190425
CHECK DATE: 9/2912010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMO UNT DESCRIPTION
1180 4343004 22.00 TRAVEL PER DIEMS
PRESCRIBED BY STATE BOARD OF ACCOUNTS 1 GENERAL FORM NO. 101 (1966)
4
MILEAGE! CLAIM
TO D. 1�
(GOVERNM AL U T)
ON ACCOUNT OF APPROPRIATION NO. 5jj�� FOR
{OFFICE, BOARD, D RTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
DA READING NATURE OF BUSINESS MILES x
POINT POINT START FINISH TRAVELED PER MILE
O
AUTO LICENSE NO. L q� TOTALS
tom. (ri
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 liowing 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 OF certify as follows:
3��/p�1 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
On Account of Appropriation No. y for
o tr w
P.y
w O
n N g m
m
Allowed 19T x w o a
n w pi
b cq
in the sum of r. m
m
m G
(D I ID
m
n a
PL 0
O CT
Q N
(Board or Commission) 0 ro M
a
FILED m
rA
a m
w n W
H
to
m a
FA
(Official Title) p m
o m
0
m' m m
A.E. BOYCE CO., INC. MUNCIE, IN 01135 a