HomeMy WebLinkAbout191574 11/10/2010 CITY OF CARMEL, INDIANA VENDOR: 363569 Page 1 of 1
ONE CIVIC SQUARE MICHAEL CALVERT CHECK AMOUNT: $15.50
CARMEL, INDIANA 46032 C/O BROOKSHRE GOLF COURSE
CHECK NUMBER: 191574
CHECK DATE: 11/10/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 15.50 MILEAGE
Prescribed by State Board of Accounts General Form_No. 101 (1955)
MILEAGE CLAIM f�
TO `1�� r p DR.
(Governmental Unit)
On Account of Appropriation No. for
(Office, Board, Department or Institution)
DATE FROM TO ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE �y
20 Point Point Start Finish TRAVELED PER MILE
/V 1
6 r 1I I�r 37 c S
-7-W t
Cl
)o -z r,( t i 3 qllL 133 q 7 t r d
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, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after
allowing all just credits, and that no part of the same has been paid.
Date Z
Clcdm No. Warrant No. I have examined the within claim and
hereby certify as follows:
IN FAVOR OF
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
On Account of Appropriation No. for
Disbursing Officer
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