HomeMy WebLinkAbout171185 04/22/2009 CITY OF CARMEL, INDIANA VENDOR: 359164 Page 1 of 1
ONE CIVIC SQUARE KEN MILLER
CARMEL, INDIANA 46032 768 GRACE COURT CHECK AMOUNT: $188.10
CARMEL IN 46032 CHECK NUMBER: 171185
CHECK DATE: 4/22/2009
DEPARTMENT AC COUNT PO NUMB INVOIC NUMBE J AMOUNT DESCRIPTION
1207 4343002 188.10 MILEAGE
1,
har�ib.d by SWAB Board a: Plat tj.
No. 141 U"
MILEAGE CLAIM
(GOVERNMENTAL- UNIT} TO t]R.
ON ACCOUNT OF APPROPRIATION NO. FO
(OFFICE. BOARD. DEPARTMENT OR INSTITUTION)
DATE FROM TO SPEEDOMETER AUTO MILEAG"
i READING+ MILES
POINT I NATUR£ OF BU SINESS TRAVELEp �ER�
POINT START rI1Vl
Ail 1
f-7 1
L3
I
3
CD
to
13
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v I
I I
e r
EtE
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 le e. after a'
and that no part of the same has been paid.
Date 5 0
Ciaim.No. Warrant No. I have examined the vii -tin. claim an_d- hereby
IN N FAVOR OF certify as follows:
That it is in proper form
That it is -duly authenticated as required
bylaw.
j
That :t is based upon statutory authority.
That it is apparently t correct
j incorrect
On Account of Appropriation No. for t7is ursing Officer
o Q
Ucwed 19 m
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in the sum of
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