HomeMy WebLinkAbout171042 04/16/2009 CITY OF CARMEL, INDIANA VENDOR: 354940 Page 1 of 1
ONE CIVIC SQUARE THOMAS PERKINS
y CARMEL, INDIANA 46032 14150 EQUINE COURT CHECK AMOUNT: $66.00
WESTFIELD IN 46074
CHECK NUMBER: 171042
CHECK DATE: 4116/2009
DEPARTMENT A CCOUNT PO NUMBER IN NUMBER AMOUNT DESCRIPTION
1180 4343004 66.00 TRAVEL PER DIEMS
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
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(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. '1�30 9' FOR
(OFFICE, BOARD, DEPARTM T OR INSTITUTION)
DATE
FROM TO SPEEDOMETER AUTO MILEA READING E
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED ED
PE
MILE
D
o r gao 99 Y� /o
9000
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AUTO 11 ENSE NO. TOTALS O QO
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 allokving all just credits
and that n�o part of the same has been paid.
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Date aAAle-z
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Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form.
That it is duly authenticated as required
by law
n That it is based upon statutory authority.
6e? mod .L That it is apparently correct
incorrect
�3a Disbursing Officer
On Account of Ap propriation No for
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