HomeMy WebLinkAbout203092 10/25/2011 a CITY OF CARMEL, INDIANA VENDOR: 360469 Page 1 of 1
ONE CIVIC SQUARE CONNIE MURPHY
CHECK AMOUNT: $13.88
CARMEL, INDIANA 46032 9 HENSEL CT
CARMEL IN 46033 CHECK NUMBER: 203092
CHECK DATE: 10/25/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
221 5023990 13.88 MILEAGE REIMBURSEMENT
h.ocib.d bi Slat. Bo d o: Arca=t..
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MILEAGE CLAIM
OVER MENTAL. IT) TO
6P� �J 1 DR.
ON ACCOUNT OF APPROPRIATION No. FO
(OFFICE. BOARD. DEPARTMENT OR INS ITJTION)
DATE FROM TO I SPEEDOMETER 1, AUTO C'ER LEAGE.
19 READING+ MILES °OINT POINT NATURE OF BUSINESS TRAVELED MILE
START FINISH
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AUTO LICENSE NO. TOTALS 11
+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 due. after allowing all just cred
and that no part of the same has been paid.
Dote
Claim No. Warrant No. I have examined the within .:elairn and.hereby
certify as follows;
IN FAVOR OF
n That it is in proper form.
That. it is -duly authenticated as required
by law.
That it is based upon statutory .authority
correct
3 That it is apparently ct
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