158850 04/30/2006 a CITY OF CARMEL INDIANA VENDOR: 065950 Page 1 of 1
ONE CIVIC SQUARE DIANA CORDRAY CHECK AMOUNT: $250.48
CARMEL, INDIANA 46032 11843 STONEY BAY CIRCLE
CARMEL IN 46033 -9501 CHECK NUMBER: 158850
CHECK DATE: 4/3012008
DEPARTMEN ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4343004 250.48 TRAVEL PER DIEMS
hraib+d by State Board o: Acovvmu.
3—"al Fo— No. 101 CIVU
MILEAGE CLAIM
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(GONE NMENTAL UNITY TO OR
ON ACCOUNT OF APPROPRIATION N0. r" FO l
(OFFICE. BOARD. DEPARTMENT OR INSTITUTION)
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DATE FROM TO SPEEDOMETER AUTO MI�P,GE<
READING+ MILES O
C NATURE OF BUSINESS j TRAVELED PER MILE
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AUTO LICENSE NO. TOTALS
+SPEEDOMETER READING columns are to be used only when distance between points cannot be delermined 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 clampedis legally due. after allowing. atl just creel
and th` no park of the same has be n paid.
Date
I
i Claim No. Warrant No. I have examined -the wi- d- tin.clnun and hereby
IN FAVOR OF certify as follows:
That it is in proper form
T"na.t. it is 'duly authenticated as .required
by -law.
That it is based upon statutory authority.
That -it is apparently correct
g incorrect
On Account of Appropriation No for Disrsing Of icer
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