HomeMy WebLinkAbout179036 11/05/2009 CITY OF CARMEL, INDIANA VENDOR: 065950 Page 1 of 1
OP;E CIVIC SQUARE DIANA CORDRAY CHECK AMOUNT: $308.85
CARMEL, INDIANA 46032 11643 STONEY BAY CIRCLE
a. CARMYEL IN 46033 -9501 CHECK NUMBER: 179036
CHECK DATE: 11/5/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUM AMOUNT DESCRIPTION
1701 4343004 308.85 TRAVEL PER DIEMS
Prescribed by State Board of Accounts
General Form No. 101 (1955)
MILEAGE CLAIM
(le h1 TO DR.
(Gove nmental Unit)
(j. -1;Wb r On Account of Appropriation No. for
(Office, Board, Department or Institution)
DATE FROM TO ODOMETER READING' NATURE OF BUSINESS AUTO MILES MILEAGE
20 I Point Point Start inish TRAVELED PER MILE
Asa so s s
o r°8f1c d! 02 o r
d� I Lo l a a
3 2
167 N l
tx 0 6 M- go
Tle r o !U
Q r4,
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 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 co J A4��
i I have examined the within claim and
Claim No. Warrant No.
hereby certify as follows:
IN FAVO
That it is in proper form;
That it is duly authenticated as required
by law;
That it is based upon statutory authority;
S correct
�O g That it is apparently incorrect
On Account of App op No. I J for
v �.t IZ V k I r l Disbursing Officer
1 (Q '0 a n
(D
Allowed 20 o
0 C
r
in the sum of o
"(p
e m
o
cn En r3'
x�
'd
m
0 0 in 9
a
(Board or Commission) C)
FILED
m
o
R
(D (D
m (DD
(Official Title)
En E
O F� (D
�e (D a