HomeMy WebLinkAbout177783 09/29/2009 CITY OF CARMEL, INDIANA VENDOR: 356305 Page 1 of 1
ONE CIVIC SQUARE DARRELL D NORRIS CHECK AMOUNT: $93.50
;t �o CARMEL, INDIANA 46032 101 2ND AVE SW, #2C
CARMEL 46032 CHECK NUMBER: 177783
CHECK DATE: 9129/2009
DEPARTMEN A CCOUNT PO NUMBER IN VOICE NUMBER AMOUNT DESCRIPTION
1160 4343004 93.50 MILEAGE
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 10i (1386)
MILEAGE CLAIM
T o
(GOVERNMENTAL UNIT)
A )1- le Q� `0 ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING
N NATURE OF BUSINESS MILES s
Afl' POINT POINT START FINISH TRAVELED PER MILE
6 -7W0/,9N/ .7-D E ('.o&- CC
d C-
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 legs ue, after allowing all s redits
and that no part of the same has been paid.
6
Date
ar
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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 uthenticated as r
Y
by law
That it is based upon statutory authority.
That it is apparently correct
incorrect
Disbursing Officer
On Account of Appropriation No. for
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