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157294 03/11/2008
CITY OF CARMEL, INDIANA VENDOR: 358829 Page 1 of 1 ONE CIVIC SQUARE PAUL BLOCKOMS CHECK AMOUNT: $313.10 CARMEL, INDIANA 46032 7033 SEA OATS LANE INDIANAPOLIS IN 45250 CHECK NUMBER: 157294 CHECK DATE: 3/11/2008 DEPARTMENT .L ACCO P O NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 905 4343004 313.10 TRAVEL, PER DIEMS pr aib.d by 3two Hoard of Aco*=u. ^,m.[ol roan No. 10: GIBS! MILEAGE CL {GOVERNMENTAL UNIT) TO �1/1 V OC, O V"t� V �O �J �D DR ON ACCOUNT OF APPROPRIATION N0. FO (OFFICE. 80ARO. OEPARTMENT OR INSTITUTION) DATE FROM TO I SPE=EDOMETER AUTO MILEAGE READING+ MILES �p r 1g POINT POINT START i"INISN NATURE OF BUSINESS f TRAVELED PER MILE I I I I MAU Ii VY I I I li I I II k I k I I 1 t 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• I hereby certify that the foregcizng account is just and correct. that the amount claimed is legally due. after allowing all just crec and that no part of the same has been paid. Date Ciairn No, Warrant No. I have examined the witl3in_ claim and.hereby IN FAVOR OF certify as follows: That it is in proper form That it is -duly authenticated as regi:ired by law. Tnat it is based upon statutory authority That it is apparently t correct incorrect Disbursing On Account of Appropriation No.�✓ for CD ©f icer C� C n o o M Uowed 19 C4 Ln the sum of ,q C o a a �fl m (Board or Commission) R x ro P a. t} H y r] p O FILED o a- 5- (Official Title) F5, o 0- Q a m m CD A "E. ROYCE M. Y UNCLE, I HO. 02]73 n n