224457 09/25/2013 CITY OF CARMEL, INDIANA VENDOR: 355377 Page 1 of 1
ONE CIVIC SQUARE LOIS CRAIG CHECK AMOUNT: $13.56
�a CARMEL, INDIANA 46032 10680 MORRISTOWN COURT
off`o CARMEL IN 46032 CHECK NUMBER: 224457
CHECK DATE: 9/25/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4343004 13 . 56 TRAVEL PER DIEMS
Pr ' ib.d by Stat• Board o: A&x m
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0e al Form No. 101 Uo*-e
MILEAGE CLAIM
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OVERNMENTAL UNIT) TO DR.
(OFFICE. 80AKD. DEPARTMENT OR INSTITUTION) " ON ACCOUNT OF APPROPRIATION N0. FOR-
AT FROM TO I SPEEDOMETER
READING+ AUTO MILEAGE
POINT POINT NATURE OF BUSINESS MILES @U
START FINISH I TRAVELED PER MILE
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AUTO LICENSE NO.
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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.
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 wi-dua,claim and.hereby
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IN FAVOR OF certify as follows:
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T°nat it is in proper 'form.
Q —!� 7nat it is -duly authenticated as required
by .law.
That it is based upon statutory authority.
That it is apparently.. t correct
�: incorrect
On Ac ount of Appropriation N0. for Dis ursing Of icer
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Ln the sum of $
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