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HomeMy WebLinkAbout200922 08/30/2011 CITY OF CARMEL, INDIANA VENDOR: 00353131 Page 1 of 1 ONE CIVIC SQUARE SANDY JOHNSON �i CHECK AMOUNT: $12.21 CARMEL, INDIANA 46032 CIO CLERK TREASURER'S OFFICE CARMEL IN 46032 CHECK NUMBER: 200922 CHECK DATE: 8130/2011 DEPARTMENT ACCOUNT PO NUM INVOICE NUMBE AMOUNT DESCRIPTION 1701 4343004 12.21 TRAVEL PER DIEMS m Prescribed by State Board of Accounts General Form No. 101 (1955) MILEAGE CLAIM DR. (Governmental Unit) C ✓�Q —�it� On Account of Appropriation No. for (Office, Board, Department or Institution) DATE FROM TO ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE 55. 5 20 Point Point Start Finish TRAVELED PER MILE Iry ��2c 111 3 .2 y S.ha r /a t— t t' n 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, 1 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 e 9 Claim No, Warrant No. I have examined the within claim and hereby certify as follows: IN FAVOR OF That it is in proper form; That it is duly authenticated as required by law; That it is based upon 4mrect tutor authority; That it is apparently U On Account of Appropri n No. for n Disbursing Officer Allowed 20 (D a t7' in the sum of o (D �J (D� M rD P (D o M� cn (Board or Comission) T m 00 I CD (D FILED N e Q Q (Official Title) O O Q