HomeMy WebLinkAbout161430 07/11/2008 CITY OF CARMEL, INDIANA VENDOR: 00353131 Page 1 of 1
ONE CIVIC SQUARE SANDY JOHNSON CHECK AMOUNT: $28.08
CARMEL, INDIANA 46032 C!0 CLERK TREASURER'S OFFICE
y; ➢ae �o CARMEL IN 46032 CHECK NUMBER: 161430
CHECK DATE: 711112008
DEPA RTMENT ACCOUNT PO NUMBER INVOICE NUMBE AMOUNT DESCRIPTION T
1701 4343004 28.08 TRAVEL PER DIEMS
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PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORM NO. 101 (1986)
MILEAGE CLAIMz,,���
TO
4 (GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
D ATE READING
MILES
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED RM C
PE R M LE
v t1 D a C� (tj 4 l o
to Do L
AUTO LICENSE NO. TOTALS r�
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 ue, after allowing all jus credits,
and that no part of the s e has been paid.
Date
s 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.
T at.t is appa ent correct
incorrect
Disbursing Officer
On Account of Appropriation No. for
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A. E. BOYCE CO., INC. MUNCIE, IN 01136 7r,
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