157540 03/19/2008 VENDOR: 00353131 CITY OF CARMEL, INDIANA Page 1 of 1
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ONE CIVIC SQUARE SANDY JOHNSON CHECK AMOUNT: $22.22
CARMEL, INDIANA 46032 C10 CLERK TREASURER'S OFFICE
L�fori,Fa CARMEL IN 46032 CHECK NUMBER: 157540
CHECK DATE: 3/19/2008
DEPARTMENT ACCOUNT PO NUM INVOICE NUMBER AMOUNT DESCRIPTION
1701 4343004 22.22 TRAVEL PER DIEMS
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO- 101 (1985)
MILEAGE CLAIM
t V 1
GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
`(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING NATURE OF BUSINESS MILES
POINT POINT START FINISH TRAVELED PER MILE
to v �n n Z z iT it
C� I
AUTO LICENSE NO. TOTALS a� a
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 legal due, after allowing all just credits
and that no part of the same has been paid.
Date
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
f incorrect
3 Disbursing Officer
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A.E. BOYCE Co.. INC. MUNCIE, IN 01136