HomeMy WebLinkAbout239070 11/11/14 `% c,q�f CITY OF CARMEL, INDIANA VENDOR: 362732
ONE CIVIC SQUARE PAMELA LISTER
CHECKAMOUNT: $********36.40*
s _�; CARMEL, INDIANA 46032 11598 MANSFIELD PLACE CHECK NUMBER: 239070
9;«oN�, CARMEL IN 46032 CHECK DATE: 11/11/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 REIMB 36.40 TRAVEL PER DIEMS
Prescribed by State Board of Accounts General Form No.101(1955)
MILEAGE CLAIM
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(Governments nit
On Account of Appropriation No. 4,36 - for Ly
Office;_Board,Department or institution)
DgTE FROM TO
ODOMETER READING NATURE OF BUSINESS AUTO MILES MILEAGE @
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20 Point Point Start Finish TRAVELED PER MILE
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Auto License No. 41/V
* SPEEDOMETER READING WILMS are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
:.Pursuant to the provisions and penalties of Chapter 155,Acts 1953,-I,hereby certify that the foregoing account is just and correct,that the amount claimed is le ally due, after
allowing all just credits, and that no part of the same has been paid. j
Date
i
Claim No. Wcurant No. I hccve examined the withm claun cazd
hereby certify as follows;
i IN FAVOR OF f
That It is in proper form;
re—
-That it is duly authenticated as re
ciui
by law'
That it is based uponstatutory author
That it is apparently
on eat
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incorrect
�. On Account of Appropriation No. -05
for
Disbursing Officer
Allowed
in the sum of$
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_ (Board or Commission)
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