163865 09/17/2008 CITY OF CARMEL, INDIANA VENDOR: 359164 Page 1 Of 1
ONE CIVIC SQUARE KEN MILLER
CARMEL, INDIANA 46032 768 GRACE COURT CHECK AMOUNT: $136.40
CARMEL IN 46032 CHECK NUMBER: 163865
CHECK DATE: 9/1712008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER A MOUNT DESCRIPTION
1150 4343004 136.40 TRAVEL PER DIEMS
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Pr-=ib-d by Stat• Board o: Acoo�rou,
�m.r al Forte No. :Ol (1 t5e
MILEAGE CLAIM
(GOVERNMENTAL UNIT)
TO D R.
(OFFICE. BOARD, DEPARTMENT OR INSTITUTION) ON ACCOUNT OF APPROPRIATION N0. FO r
DATE FROM II
TO SPEEDOMETER
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POINT
READING+ I AUTO MILEAGE
POINT NATURE OF BUSINESS TRAVELED @ER MILE START FINISH
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AUTO LICENSE No.
TOTALS I
+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 all just cre
e due. owin w
and that no part of the same has been paid. g y q
Date Z D
Claim No. Warrant No. I have examined the w dun claim and hereby
certify as follows:
IN FAVOR OF
That it is in proper 'form
T'nat it is duly authenticated as required
by law.
'chat :t is based upon statutory authority.
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That it is apparently correct
incorrect
On Account of Appropriati,ori hlo. for Dis ursing Of leer J
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A BOYCE CO.. MUMCIC, IND. 40i71