HomeMy WebLinkAbout165881 11/12/2008 �f CITY OF CARMEL, INDIANA VENDOR: 359164 Page 1 of 1
ONE CIVIC SQUARE KEN MILLER
-aARMEL, INDIANA 46032 768 GRACE COURT CHECK AMOUNT: $153.12
CARMEL IN 46032 CHECK NUMBER: 165881
no
CHECK DATE: 11/12/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1150 4343004 153.12 TRAVEL PER DIEMS
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Prescribed by State Board o: Acoa=tx, f
e „sacral Form No. 101 atpr
MILEAGE CLAIM
(GOVERNMENTAL UNIT) TO DR.
(OFFICE. BOARD, DEPARTMENT OR INSTITUTION) ON ACCOUNT OF APPROPRIATION NO. FO
D°_ F ROM
�a� TO I SPEEDOMETER
READING+ AUTO MILEAGE
2�$ °OIN7 POINT NATURE OF BUSINESS I TRAVELED
START FINISH I PER MILE
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1 31
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+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 ally due. after allowing. all just creel
and that no part of the same has been paid.
Date
Claim No. Warrant No. a
I have exmined the wi #:hn :claim and hereby
IN FAVOR OF certify as follows:
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 t correct
incorrect
On Account of Appropriationi No. Ior this ursing Officer J
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