HomeMy WebLinkAbout190689 10/13/2010 a CITY OF CARMEL, INDIANA VENDOR: 363569 Page 1 of 1
ONE CIVIC SQUARE MICHAEL CALVERT CHECK AMOUNT: $7.00
CARMEL, INDIANA 46032 CIO BROOKSHIRE GOLF COURSE
CHECK NUMBER: 190689
CHECK DATE: 10/13/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 7.00 MILEAGE
hraib.d by Star Hoard o: A=0=u. .,na.rd Foaa No. !01 utu
Cc P rcu L e q., L (2-A, DR,
MILEAGE CLAIM
(GOVERNMEN L UNIT) TO 1" v"
ON ACCOUNT OF APPROPRIATION NO. -FO
(OFFICE, BOARO,-DEPARTMENT OR INSTITUTION)
DATE FROM SPEEDOMETER AUTO
TO MILEA
I READING+ MILES �p
POINT POINT START FINISI !MATURE OF BUSINESS I TRAVELED PER MILE
t kA L I 3 Z S
I
1
it i I
I
I
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AUTO LICENSE NO. TOTALS
+SPEED(DM£'TER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway reap.
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 cr?d
and that no part of the scone has been paid
C,luim No. Warrant No. I have examined the v i n.:claim- and. hereby
IN FAVOR OF
certify cis follows:
yy� T'nat it is in proper form
LL •That. it is duly authenticated as required
by law.
u That it is based upon statutory authority.
That it is apparently correct
incorrect
On Account of Appropriation No. ;or i7is ursing Officer J
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(Board or Commission)
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A.Z. BOYCE CO., W-CIC,