HomeMy WebLinkAbout196473 04/13/2011 CITY OF CARMEL, INDIANA VENDOR: 360469 Page 1 of 1
ONE CIVIC SQUARE CONNIE MURPHY
CARMEL, INDIANA 46032 9 HENSEL CT CHECK AMOUNT: $28.56
CARMEL IN 46033
CHECK NUMBER: 196473
CHECK DATE: 4/13/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4343004 REIMB 28.56 TRAVEL PER DIEMS
Prescribed by State Board of Accounts
General Form No. 101 (1955)
MILEAGE CLAIM
T
TO L DR.
Governmental Unit)
�)t On Account of Appropriation No. for
(Office, Board, Department or Institution)
DATE FROM TO ODOMETER READING' NATURE OF BUSINESS AUTO MILES MILEAGE 5
20 Point Point Start Finish TRAVELED PER MILE
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, an that no part of the same has been paid.
Date 4 2_
Claim 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;
n That it is based upon statutory authority;
J That it is apparently correct
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