221917 07/17/2013 CITY OF CARMEL, INDIANA VENDOR: 00351917 Page 1 of 1
ONE CIVIC SQUARE CARMEL FIRE DEPARTMENT AUXILIARY
CARMEL, INDIANA 46032 CIO CARMEL FIRE DEPT CHECK AMOUNT: $319.23
? CARMEL IN 46032
CHECK NUMBER: 221917
CHECK DATE: 7/17/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4359000 319 . 23 SPECIAL PROJECTS
Prescribed by State Board of Accounts General Form No.101(1955)
WLEACE CLA�6�1i
TO .���a� DR.
(Governmental nit
On Account of Appropriation No. for
(Office,Board,Department or Institution)
DATE FROM TO ODOMETER READING' NATURE OF BUSINESS AUTO MILES MILEAGE @ •SSS
20 Point Point Start Finish TRAVELED PER MILE
IZZ
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Auto License No. TOTALS °, �3
*SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. I
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
i
Claim ga Warrant No. !§ave examined the within claim and
hereby certify as follows:
IN FAVOR of
That«3b proper llom
That it 6 duly authenticated as required
by law;
That it 6 based ego statutory,authority;
_ correct
That it m apparently rapparently c z
$ �*� .�� incorrect
On Account of Appropriation g& for
Disbursing Offic
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