HomeMy WebLinkAbout177552 09/29/2009 CITY OF CARMEL, INDIANA VENDOR: 363094 Page 1 of 1
ONE CIVIC SQUARE, ANITA AHERN CHECK AMOUNT: $74.80
CARMEL, INDIANA 46032 C/O BROOKSHIRE GOLF CLUB
CHECK NUMBER: 177552
9
CHECK DATE: 9/2912009
DE PARTMENT ACC PO NUMBER INVO NUM AMO UNT DESCRIPTION
1207 4343004 74.80 TRAVEL PER DIEMS
Prescribed by Stale Board of Accounts General Form No. 101 (1955)
MILEAGE CLAIM
207 TO DR.
(Governmental Unit)
I On Account of Appropriation No. for
(Office, Board, Department or Institution)
I
I
DATE FROM TO ODOMETER READING' NATURE OF BUSINESS AUTO MILES MILEAGE
20 Point Point Start Finish TRAVELED PER MILE
3 -1 7- 0 q K I✓ 0� C U8 5 S C 0 0 3 1970 5 L.L O-A L- /Z;? u sappaAs 35
g- 5V5c0 9WK5NIRE OQL-r- CLUE 8 ?05-6 8 0 R Td AIVRK 3
9.
5Yt5 BUG atAb 1 97X3 3
/S SWIG 8 /3 i
3 -0 1 1P79' 13 i
/8 Oq 6f
Auto License No. TOTALS 0 90
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, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after
allowing all just credits, and that no part of the same has been paid.
Date
Claim No. Warrant No. I have examined the within claim and
hereby certify as fcllows:
IN FAVOR OF
That it is in proper form;
ry 4
Tha authenticated at >.t 15 duly authe d as required
by law;
That it is based upon statutory authority;
That it is entl correct
y incorrect
On Account of Appropriation No. for
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