217151 02/13/2013 CITY OF CARMEL, INDIANA VENDOR: 366663 Page 1 of 1
0 ONE CIVIC SQUARE AMANDA GILLIM
CHECK AMOUNT: $1
CARMEL, INDIANA 46032 C/O PARKS
CHECK NUMBER: 217151 7151
CHECK DATE: 2/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 159 . 76 TRAVEL FEES & EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM IIO.101(1486)
MILEAGE CLAIM
To hm
(GOVERNMENTAL UNIT) -
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD,DEPARTMEKT OR 1NSnTVriON)
SPEEDOMETER
�DAT€ FROM TO READING + NATURE OF BUSINES6 AUTO Q c
POINT POINT START FINISH TRAVELED
PER MILE
--40
23 C. f -- —
I u Z4 T
Lu N
0 4 '1T K(C.
I0 o I r4t T Pro 2•(oQi
I V _ CL C k-
O 13 1 1L —
t 1 t4l T rA CC
1 MT
I MCC, n s ` -
_ I I 1 Ll: V i
( ( I CL i t
i 2 V1
g L^
Ll
C —
1I b M cc_ —
l1 C 2
( k9 W
f► _.._ I Rc-ci U•13
t -- MCC
12 C
11 1 `''1 r C '3.
AUTO LICENSE NO. O ` 0 L3 1 2 TOTALS I O I ,-16 "'i-0 112.V
+ 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 aliowinq just credits
end that no part if the sa a has been paid.
Date_, �_ L---
JAN 21 2013
BY.
PIVSCRIBCD BY STATE BOARD OF ACCOUNTS
GENERAL FORM NO.10)(1906)
MILEAGE CLAIM
(GOVERNMENTAL UNIn ON ACCOUNT OF APPROPRIATION NO. FOR
(OMCL,BOARD,DEPARTMENT OR INSrMTrION)
SPEEDOMETER AUTO
DATE
FROM TO I READING + NATURE OF BUSINESS baus 7 7
2a 11�/7�
POINT POINT START FINISH TRAVELED
PER MILE
T C C ----- `� ----
T GC
I
1 r mcr
C-
q 4 I MCC
Z5 1 MT c
2�1
3.14 -
_ M cC. 3 i
G R
16 0.5 11_ GL --
I I
10 3 MT _ CL Ll
10 14 -- T - GL
1 u tom, M-r
to iip -- I
10 1 )'1
AUTO LICENSE NO 3 U 3 Z TOTALS 9
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be deterrained by fixed mileage or official highway map. �y
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 aliowinq all j its.- —TV
end that no part of the sa a has been paid.
Date \
�q3x� b i
JAN 21 2013
�v:
i
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORE NO.101(1986)
MILEAGE CLAIM HIM L �J
TO(GOVERNMENTAL UNI'n
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD,DEPARTMENT OR 1NSTiTI)TION)
SPEEDOMETER
DATE FROM - TO READING + AUTO
NATURE OF BUSINESS MILES C4�ff T
--��= POINT POINT START FINISH TRAVELED PER MILE
tt — ---'
1 1 CC
i T M GC __._
—T M.CL
MCC
y f�O
C
L 9 MT -
CG
O GL
M
C _
1 I
Kr M c_ .v
L
_
S
.•� M T WC
i MCC_ /-�
AUTO LICENSE NO.
_ y c
+ 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 clai ad is legally due,after aliowing all 'ust credits
end that no p rt,of t e a has been paid.
Date RIEC ) T
JAN 21 2013