162391 08/07/2008 f CITY OF CARMEL, INDIANA VENDOR: 359213 Page 1 of 1
ONE CIVIC SQUARE JOHN JUDAY
CARMEL, INDIANA 46032 8434 SKIPPERS COURT CHECK AMOUNT: $63.18
AVON IN 46123
CHECK NUMBER: 162391
CHECK DATE: 8/7/2008
DEPARTM ACCOUNT PO NUM I NVOICE NUMBER AMOUNT DESCRIPTION
1150 4343004 63.18 TRAVEL PER DIEMS
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p,r=ibtd by Slat• Board o: Acoo=u. r o—. mj Form No. tot ut*t
MILEAGE CLAIM
DR.
(GOVERNMENTAL UNIT) TO
ON ACCOUNT OF APPROPRIATION N0. FO
(O FFICE. BOARD. DEP TO INS TITUTION)
DATE FROM TO SPEEDOMETER I AUTO MILEAGE
READING+ I MILES
19 NATURE OF BUSINESS I TRAVELED PER MILE
Of
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 elnount claimed is legally due. after allowing. all just cry'
and that no part of the same has been paid.
Dcte
(:faun No. Warrant No. I have examined -the widen. claim and ereby
IN FAVOR OF
certify as follows:
That it is in proper "form
That. it is -duly authenticated as requL d
by .law.
That it is based upon statutory aufficrit•.
That it is apparently t correct
incorrect
On Account of Appropriate n No, for Disb ursing Officer
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