232273 05/07/14 y d.c�gb
�./ CITY OF CARMEL, INDIANA VENDOR: 362732
® ONE CIVIC SQUARE PAMELA LISTER CHECK AMOUNT: $••'"•""101.36"
;.. ��� CARMEL, INDIANA 46032 11598 MANSFIELD PLACE CHECK NUMBER: 232273
'i,,�TON� CARMEL IN 46032 CHECK DATE: 05/07/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 101.36 TRAVEL PER DIEMS
'roscribod by Stole Board o(Accounts MILEAGE CLAIM
AA
V 1v� / ,�•� General Form No.101(1 D55)
TO
Governments nit) DR.
I � - I _ On Account of Appropriation No. �< �-Q
(office Boar , epartment or ns tut on fOr Y
... ......... ...
TO . '�.
DATE FROM ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE
Zp " Point Point start Finish TRAVELED
G 9 �' 9 �/, PER MILE
tt 0 7 rt
,1120 1
3 ti` t t Lt r�.:.. 02`7 vl .n
3170 c�
_ It
vx
ti 1
s eqL.t k
64r a
1A v1- Vi , �� 1!
0 V
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-9953, I hereby certify that the foregoing account is just and correct,that the amount claimed fly due,after
allowing ail just credits,and that no part of the same has been paid.
I
I
Claim No. Warrant No, _ I have examined the within claiim card
hereby certify as follows;
IN FAVOR OF
That it is in proper form;
That it is dui authenticated as r
_ Y ecp1i
._...... 1._._...__.... ,by law,
bas
_ That it`is ed upon statutory autho,
.. correct
rsr�.correct
` That it is apparently
- _
On.Account of Appropriation No.��-6 for
Mbursing Officer
I '
-Allowed
in the sum of
Lo
(Board or Commission),
I�
FILED
(Oplciai Tiue) j'
0