HomeMy WebLinkAbout201319 09/13/2011 CITY OF CARMEL, INDIANA VENDOR: 00353070 Page 1 of 1
*f ONE CIVIC SQUARE DAVID MCCOY
o CARMEL, INDIANA 46032 C/o CHECK AMOUNT: $37.75
C/o is CHECK NUMBER: 201319
CHECK DATE: 911312011
DEPARTMENT A PO NUMBER I NVOICE NUMBER AMOUNT DESCRIPTION
2200 4343002 37.75 EXTERNAL TRAINING TRA
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
C C) C �L TO
���`D
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
DATE FROM TO SPEEDOMETER AUTO MTr.Fnrg
READING NATURE OF BUSINESS MILES
19 POINT POINT START FINISH TRAVELED
PER MILE
2 C T`( L .MiL N Co cdu, i� C S 6) �1 1\
AM r�ian� C m
vu u rz c I (-L 11 s L)
uG C Y Nt A- LL 4A M i L,7t� C-0 t 4
1L�JCe c1TY 4A LL_
S i' C I T`f C A L L M I ,.1 C,' CC)&k1fT1t W E P I C J' OP D/tT,4 6. :is
AM t; CC) T?ivu S c rr< IiAt
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AUTO LICENSE NO. TOTALS V 6Z
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 legall due, after allowing all jus credits
and that no part of the same has been paid.
Date l
Claim No. Warrant No. I have examined the within 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 correct
incorrect
Disbursing Officer
On Account of Appropriation No. or
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