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HomeMy WebLinkAbout169930 03/18/2009 CITY OF CARMEL, INDIANA VENDOR: 120950 Page 1 of 1 ONE CIVIC SQUARE DOUGLAS HANEY CARMEL, INDIANA 46032 CIO DEPT OF LAW CHECK AMOUNT: $118.39 C/O DEPT OF LAW CHECK NUMBER: 169930 CHECK DATE: 3118/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBE AMOUNT DESCRIPTION 1180 4343004 118.39 TRAVEL PER DIEMS i PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986) MILEAGE CLAIM C TO (GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO "yJ�O FOR (OFFICE, BOARD, DEPARbkNT OR INSTITUTION) DATE FROM TO SPEEDOMETER AUTO MILEAGE READING NATURE OF BUSINESS MILES ..X POINT POINT START FINISH TRAVELED PER MILE D o 4 05 k O g o kiog '40 l.S �Y 5 C o S Sa 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, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due after allowing all just credits and thT part of the same has been paid. Date 1 3 0tq'zQ ©q Claim No Warrant No. I have eamndthewttncl maahab IN FAVOR OF certify as follow: That it is in proper form. That a B duly authenticated as required by law. That aa based upon statutory authority correct Tgaaaprn incorrect 2 Disbursing e On Account 2 Appropriation No ya° o t a n m� ƒW Allowed ,lg� m n q p in the sum of f (D E (D m la. E ƒ� '4 (Board aCommission) lb FILED a §7 K �W\ off mm 7 0 e E e�, INC. IN 01136 n