162582 08/14/2008 CITY OF CARMEL, INDIANA VENDOR: 00350917 Page 1 of 1
ONE CIVIC SQUARE KIM ROTT CHECK AMOUNT: $16.14
,o CARMEL, INDIANA 46032
CHECK NUMBER: 162582
CHECK DATE: 8/14/2008
D EP AR TMENT ACC OUNT PO N UMBER INVOIC NU MBER AMOUNT DESCRIPTION
1301 4343002 T 16.14 EXTERNAL 'TRAINING 'TRA
i
I
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE" CLAIM
TO i ivr,
(GOVERNMENTAL UNIT) rr ff
ON ACCOUNT OF APPROPRIATION NO. T�O Of FOR
(OFFICE, BOARD, DEPARTMENT OR INSMUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING NATURE OF BUSINESS MILES
0� POINT POINT START FINISH TRAVELED
PER MILE
b� L r t u r �r 0 Oa. lG 1 0�?
p. 11 13 0
AUTO LICENSE NO, 'TOTALS
SPEEDOMETER READING columns are to be used only when distance between points cannot bed determined .tv fixed mileage or official highway map.
i
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 credits
and that no part of the same has been paid"
Date
Claim \o Warrant No. I have examined thew thincaim and hereby
I FAVOR OF certify as follows:
That aam proper form-
That aBduyathenticgeaequrd
b law
That it B based upon statutory authority
That 3 is pamdl f core
incorrect
ƒ ƒ ƒ2 Disbursing Officer On Account of Appropriation Ko f r
o tr a
k 2
Allowed .l M ƒ
F
in the sum of «9
M
t C
f
a
9L o
0 o
(Board orCommission)
±CD
n a E
FMM
M 9 b
\ƒ
(Official Title) o a .4
0
k e CD
tr
A.X. BOY CE CO.. INC. .IN S a 2 n