HomeMy WebLinkAbout174727 07/22/2009 CITY OF CARMEL, INDIANA VENDOR: 363094 Page 1 of 1
e 4 ONE CIVIC SQUARE ANITA AHERN CHECK AMOUNT: $81.95
CARMEL; INDIANA 46032 CIO BROOKSHIRE GOLF CLUB
CHECK NUMBER: 174727
CHECK DATE: 7/22/2009
"SEPAR TMENT ACCOUNT_ PO NUMBER INVO ICE NUM l J AMOUNT DES
1207 4343004 MILEAGE 81.95 TRAVEL PER DIEMS
Prescribed by State Board of Accounts General Form No. 101 (1955)
MILEAGE CLAIM,
i
TO DR.
(Governmental EJnit
1.2 On Account of Appropriation No for
(Office, Board, Department or Institution)
DATE- FROM TO ODOMETER READING* NATURE OF BUSINESS 5S
AUTO MILES MILEAGE 4
20 Point Point Start Finish TRAVELED PER MILE
-Q R 60 5 C 66Ll CLu G, CC M19 X 19 /8 .5 .9' E 7-6q R-) s1W29EX 75
_D OFr /C� MFa 5 SCa FDO1a �ERv�cE /u a �8 OiC' wIL4 C�LL /7-"� 9. 3 5
q I S 5C0 FOOL) SE 900KS�4iRE G01F CLUIS 19416 E /fl✓{ R�uRAI 772 B ao Slim 35
ZcI SY CO FOVO V CL l /C -C[P ALL CALL- D121� 8. 0
SCO F60D SER k GdL� C'L 510 �f RE P 8 O t', S. 1 00
X &05 /D 5m�o 5
1 @4610 /ezI 61 15 ,191i&
CG -O� 12. l�y�(o� /t`f�/✓ Z�..t -C.0 (�tC.0 ivn�Le� 10 5
'7- -0 533 5- 7 5
350 1856 7 1 2< 3
Auto License No. TOTALS nK�;{,U
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
xs n
suant 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
�e 26Ang all just credits, and that no part of the same has been paid.
Date '7 /U 017
Clam No, Warrant No. I have examined the within claim anc
hereby certify as follows,
IN FAVOR OF
That it is in proper form;
That it is duly authenticated as xec xuired
by law;
That it is based upon statutory aut hority;
That it is apparently correct
incorrect
On Account of Appropriation No, for
Disbursing Officer
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el
Allowed 20 (D 0 o
in the sum of o
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to (D Q
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(Board or Commission) I �e
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