211605 08/14/2012 CITY OF CARMEL, INDIANA VENDOR: 080501 Page 1 of 1
j_ ONE CIVIC SQUARE CINDY SHEEKS CHECK AMOUNT: $13.32
CARMEL, INDIANA 46032 13791 LAREDO DRIVE
roN�o, CARMEL IN 46032 CHECK NUMBER: 211605
CHECK DATE: 8114/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4343004 13 . 32 TRAVEL PER DIEMS
}t.,=Rb d by Btat. Board o:Aroo=t.. 0-01 Form No. 101 UCU
MILEAGE CLAIM
4 V✓J
( OVE MEN T L UNIT) TO DR.
ON ACCOUNT OF APPROPRIATION NOL�FOR�� 1L��1 �K p
(OFFICE. BOARD, DEPARTMENT OR INSTITUTION)
DA E FROM TO I SPEEDOMETER I I AUTO MILEAGE (�
READING+ 4 MILES
POINT POINT START FINISN NATURE OF BUSINESS I TRAVELED PER MILE
11 1 AP I
1
t
DIU I
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)
2
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 cred
and that no part of the same has been paid.
Date
Claim No. Warrant No. I have examined the within.claim and.hereby
IN FAVO�R/ OF
certify as follows:
'I"nat it is in proper form.
That it is -duly authenticated as required
by law.
That it is based upon statutory authority.
That it is apparently i correct
� incorrect
On Account of Appropriation No, IoM Dis ursing Of icer
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Allowed 19 y a
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