227600 12/31/2013 CITY OF CARMEL, INDIANA VENDOR: 080501 Page 1 of 1
ONE CIVIC SQUARE CINDY SHEEKS CHECK AMOUNT: $13.56
CARMEL, INDIANA 46032 14382 WHISPER WIND DR
CARMEL IN 46032 CHECK NUMBER: 227600
CHECK DATE: 12/31/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4343004 13 . 56 TRAVEL PER DIEMS
Prescribed by State Board of Accounts General Form No.101 (1955)
MILEAGE CLAIM
CAAOJ-� TO l/`�'1 I Wil/ �l.��it� DR.
(Governmental Unit)
0-T Q-m
ca— On Account of Appropriation No. V for1l� il
(Office, BoarVILDepartment or Institution)
DATE FROM TO ODOMETER READING" NATURE OF BUSINESSis/
AUTO MILES MILEAGE
20 Point Point Start Finish 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. i
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
Claim No. Warrant No. I have examined the within claim and
hereby certify as follows:
I FAVOR OF
i
That it is in proper form;
That it is duly authenticated as required
by law;
That it is based upon statut thority;
That it is apparently come
$ ,�j correct
On Ac ount of Appropriation No. v J for
Disbursing Officer
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Allowed 20 ¢
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in the sum of$ o -
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