159428 05/14/2008 C „wr CITY OF CARMEL, INDIANA VENDOR: 359213 Page 1 of 1
(o ONE CIVIC SQUARE JOHN JUDAY
CARMEIL, INDIANA 46032 8434 SKIPPERS COURT CHECK AMOUNT: $115.65
'tiy` AVON IN 46123 CHECK NUMBER: 159428
CHECK DATE: 5I14l2DOB
DEPARTMENT ACCO PO NU MBER INVOICE NUMBER AMOUNT DESCRIPTION
905 4343004 115.65 MILEAGE
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havib.d by 9tal. Board o:.lcb�u. r
yea acal Fa= No. 101
MILEAGE CLAIM J
(GOVERNMENTAL UNIT) T v! �v` v rl
ON ACCOUNT OF APPROPRIATION N0. FO
(OFFICE. BOAR'O,- DEPARTMENT OR INSTITUTION)
DATE FROM TO SPEEDOMETER AUTO M]
19 READING+ MILES
POINT POINT FINISH NATURE OF BUSINESS TRAVELED PER MILE
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E I i i AUTO LICENSE NO. TOTALS 1 �L.
+SPEEDOMETER READING cola nns 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 cl is e er allowing all just creel
and that no part of the same has been paid.
Date G��
Claim No, Warrant No. I have examined the witluz -clai M -and. herebY
IN FAVOR OF
certify as follows:
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That it is in proper form.
�1} `ha}. it is -duly authentic -ated as required
by law,
iat :t is based upon statutory authority-
That it is apparently correct
incorrect
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