HomeMy WebLinkAbout217440 02/19/2013 CITY OF CARMEL, INDIANA VENDOR: 366785 Page 1 of 1
ONE CIVIC SQUARE BONNIE LEWIS CHECK AMOUNT: $18.32
CARMEL, INDIANA 46032 C/O COURT
CHECK NUMBER: 217440
CHECK DATE: 2/19/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1301 4343004 18 . 32 TRAVEL PER DIEMS
Prescribed by State Board of Accounts General Form No.101(1955)
,, MILEAG t CLAIM , 0 -,
p"O't i V:t . TO
l
Governmental Unit
On Account of Appropriation No. 7 �� � � �7 for
Office,Board;Department or Institution)
DATE FROM TO
ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE @
20 C Point Point Start Finish I TRAVELED PER MILE
Auto License No. TOTALS -
*SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155,Acts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after
allowing all just credits, and that no part of the same has been paid.
Date
Claim No. Warrant No, I have examined the within claim and
hereby certify as follows:
IN FAVOR OF
&1ki/Ij l CS GL(l t That it is in proper form;
That it is duly authenticated as required
by law,
That it is based upon statutory authority;
-- That it is apparently f correct
� . incorrect
On Account of Appropriation No. "b for
Disbursing Officer
_ 0 - 0
Allowed 20 SQy o o
in the sum of$ o
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(Board or Commission)
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