HomeMy WebLinkAbout224730 10/01/2013 CITY OF CARMEL, INDIANA VENDOR: 080501 Page 1 of 1
ONE CIVIC SQUARE CINDY SHEEKS
CARMEL, INDIANA 46032 14382 WHISPER WIND DR CHECK AMOUNT: $13.56
CARMEL IN 46032
CHECK NUMBER: 224730
CHECK DATE: 10/1/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4343004 13 . 56 MILEAGE FEES
hraibod by State Board o: Acootmu.
Oea.al Foms No. 101 UI*C
r MILEAGE CLAIM -�
(GOV�- NMENTAL UNIT) TO � DR
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(OFFICE. BOARD. DEPARTMENT OR INSTITJTION) ON ACCOUNT OF APPROPRIATION NO. FOR
DATE FROM TO I SPEEDOMETER I
19 READING+ AUTO MILEAGE MILES @
%tut"/ POINT POINT START FINISH NATURE OF BUSINESS I TRAVELED PER MILE
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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 claimed is legally due. alter allowing.all just creel
and that no part of the same has been paid.
Date
Ciaim No. Warrant No. I have examined the wiffiin.claim and hereby
IN FAVOR OF certify as follows:
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 _ crrect
z fn'cor-rect
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