HomeMy WebLinkAbout236650 09/03/14 (9,
CITY OF CARMEL, INDIANA VENDOR: 362732
CHECK AMOUNT: $********62.72*ONE CIVIC SQUARE PAMELA LISTERCARMEL, INDIANA 46032 11598 MANSFIELD PLACE CHECK NUMBER: 236650
CARMEL IN 46032 CHECK DATE: 09/03/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 62.72 TRAVEL PER DIEMS
'roscrlfioilbyStele Board aFAccounts
: MILEAGE CLAIM
MILEAGE General Form No,101(1 9r,5)
GOVemmenta nit) DR. .
r
� (,� n Account of Appropriation No.
L-(4
Off ce,Board,Department or nst tut on
r�
FROM TO ODOMETER READING*
NATURE OF BUSINESS AUTO MILES MILEAGE @ �
Poirot Point Start Finish TRAVELED
20 PER MILE
09 .
SU a ul I a
17
u l
c t ut 3
,1A
IL
V/ �� tc
Auto'Ltcense No. TOTALS
*
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
:Pursuant toahe provisions and penalties of Chapter 155 Acts 1953,:,1.hereby certify..that the foregoing account is just and correct,that the amount claimed is l ue,after
rt of the same has been paid.
allowing all just credits,and that no pa
Claim No. warrant No. I have excndned the witivn claim and
hereby certify as follows;
IN FAVOR OF
That'it is in proper form;
_...__ That it is .
duly authenticated as requi
by law, .. .:
That,it is based upon statutory author
C
p ..
correct
That it is ap arentIy
incorrect
On Account of Appropriation No.' - for
Disbursing officer
Allowed N p;
in the sum of$ R
� �
(Dowd or commission) N
FILED
ty
.010
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(Official Tiue) r
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