161483 07/11/2008 CITY OF CARMEL, INDIANA VENDOR: 359164 Page 1 of 1
f. ONE CIVIC SQUARE KEN MILLER
CARMEL, INDIANA 46032
768 GRACE COURT CHECK AMOUNT: $117.16
CARMEL IN 46032 CHECK NUMBER: 161483
CHECK DATE: 7/11/2008
Gt-:PARTMENT ACCOUNT PO NUMBER INV OICE N AMOUNT DESCRIPTION
905 4343004 117.16 TRAVEL PER DIEMS
f
4
t.
g a
g
►ra ib.d by Star Board o: Acc i=ts.
G—. al Form No. 101 UtSt
MILEAGE CLAIM
(GOVERNMENTAL UNIT)
TO DR.
(OFFICE. BOARD, DEPARTMENT OR INSTITUTION) ON ACCOUNT OF APPROPRIATION NO. FO
DATE TO
FROM I SP EEDOME TER
D
AUTO MILF.f+.GF�
=DINT MATURE OF BUSINESS I MILES @p t
POINT START PINISN TRAVELED PER M[LE
k I VL L j o
't
Co
C; I e ✓e2 C/� asp s
Ll
r I o
i/ o
/Z
D
i6 16
Ll
�s o
P D
L
I .I
d
C)
I v
AUTO LICENSE NO.
TOTALS I oC3 1 17
+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 le
and that no part of the same has been paid. Y er allowin4. all just cred
Date 4/3, /0cg
Claim No. Warrant No. I have examined -the widen 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 ccount of Appropriation No. Ior
Disbursing Of icer
C o p rn
A1owed 19 Ca
0 o
fn the sum of
a
Or
a co p
CD
(Board or Commission) x a
m m
27 H R
Q Cl)
FILED o t�
a
1 CD
(Official Tide) Q G
a s
A.C. BOYCC CO., MVMCI[, IMO. 00]1] .7