155293 01/10/2008 CITY OF CARMEL, INDIANA VENDOR: 355377 Page 1 of 1
j 0 ONE CIVIC SQUARE LOIS FINE
CARMEL, INDIANA 46032 10680 MORRISTOWN COURT CHECK AMOUNT: $10.67
CARMEL IN 46032 CHECK NUMBER: 155293
CHECK DATE: 1/10/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4343004 10.6.7 TRAVEL PER DIEMS
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hrmib.d by Stat. Board o: Ac==t.. Omaal Form No. 101 Uett
MILEAGE CLAIM
FtRNMENTAL`UNIT) TO V DR.
ON ACCOUNT OF APPROPRIATION NO FO
(OFFICE. BOARD, DEPAR OR I
SPEEDOMETER f AUTO MILEAGE
DA E FROM TO READING+ I MILES G
g NATURE OF BUSINESS
TRAVELED PER MILE
POINT POINT START FINISH
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AUTO LICENSE NO. TOTALS
+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 legally due. after allowing. all just creel
and that no part of the same has been paid.
Date
�1
Claim No.
Warrant No. I have examined .the within claim :and.herelJy
IN FAVOR OF certify as follows:
That it is in proper #orris.
That. it is -duly authenticated as :required
by law.
That it is based upon statutory authority.
That it is0apparen•'y f correct
in r ct
07
On Account of Appropriation No, �3�D Dis ursing Of icer
AllovQed 19 a
in the sum of
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(Board or Commission)
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(Official Tide)
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