HomeMy WebLinkAbout212358 08/28/2012 CITY OF CARMEL, INDIANA VENDOR: 364657 Page 1 of 1
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!. ONE CIVIC SQUARE JESSICA RICHARDS CHECK AMOUNT: $155.21
CARMEL, INDIANA 46032 1832 N GLENDORA DR
INDPLS IN 46214 CHECK NUMBER: 212358
CHECK DATE: 8/28/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 70 . 92 TRAVEL FEES & EXPENSE
1082 4343000 84 .29 TRAVEL FEES & EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENTAALFORM 110.101(1986)
MILEAGE CLAIS�C� I�I� \�X as
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(GOVERNMENTAL UNI'[)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF-,ICE,BOARD,DEPARTMENT OR INSnMION)
SPEEDOMETER
AUTO 14ILEAGE
DATE FROM TO I B,"ADING i-
20 y NATURE OF BUSINESS MILES @ S S5
POINT POINT START' FINISH TRAVELED PER MILE
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+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map, VV
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 c coed is legally due after a'owing a ) credits
end that no p rt of the same has been paid.
Date
t
AUG 2 2 2017
PRESCRIBED BY STATE BOARD OF ACCOUNTS J GENERAL FORM 110.101(1986)
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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 claime ,L ally due,aft r al'owing all t credits
end that no pa4t of tl e�same has been paid. (� /�/✓�
Date lSn/ ,y'V C� —
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Pursuant to the provisions and penalties of Chapter 155,Acts 11133,I hereby certify that the foregoing account is Just and correct,that the amount c is 1 y owing t credits.-
end that of the ipme has been paid.
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[ AUG 2 2 2012