166065 11/19/2008 CITY OF CARMEL, INDIANA VENDOR: 080501 Page 1 of 1
ONE CIVIC SQUARE CINDY SHEEKS
s..� CARMEL, INDIANA 46032 '3791 LAREDO DRIVE CHECK AMOUNT: $14.63
CARMEL IN 46032 CHECK NUMBER: 166065
CHECK DATE: 11/19/2008
DEPART ACCOUNT PO NUMB INVOIC NUMBER AMOUNT DESCRI
1701 4343004 14.63 TRAVEL PER DIEMS
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Tr "aib-d b7 Star R—d o: Mxnmu. ^,eo Ord Fo rta No. I01 utte
MILEAGE CLAIM
GOVERN ENTAL. UNITI TO R.
0(6)-Utla
ON ACCOUNT OF APPROPRIATION NO— 42) 24"'
BOARD, DEPARTMENT OR INSTITUTION)
DATE FROM TO SPEEDOMETER I AUTO MILEAGE
READING+ 1 MILES 5R;�" f
19 NATURE OF BUSINESS t TRAVELED PER MILE
POINT POINT START �INISi I
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I 11
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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 mag.
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 Maimed is legally due. after allowing. all just creel
and that no part of the same has been paid.
Date