HomeMy WebLinkAbout240522 12/23/14 (9,
CITY OF CARMEL, INDIANA VENDOR: 362732
ONE CIVIC SQUARE PAMELA LISTER CHECKAMOUNT: $********27.44*CARMEL, INDIANA 46032 11598 CARMEL IN FIELD PACE CHECK NUMBER: 240522
CHECK DATE: 12/23/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 MILEAGE 27.44 TRAVEL PER DIEMS
3rescdbed by State Board of AccountsIVIILEA�CE CLAIM General Form No
,109(11)651
TO r
t (Governments nit) t
DR.
O
0 r n Account of Appropriation No, q'�c-a[�G�`for
o ,
Off ce,Board,DepaAment or ns to on r
FROM TO READING' -
ODOMETER READ
DATE NATURE OF BUSINESS AUTO MILES MILEAGE
2U Point Point . Start Finish TRAVELED
2x— 1'0/ 53/ 6& PER MILE
t00%-
Zvi / �' 3
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h
V_ z �33g3 33 P L
(4 3
Auto License No. TOTALS
7
* 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;,.1 hereby certify that the foregoing account is just and correct,that the amount claimed is to ally due,after
allowing all just credits,and that no part of the same has been paid.
Claim No Warrant No. I have excamined-the within:claim cmd
- hereby certify as follows:
IN FAVOR OF
- i is
Thak:t. in proper form;
- . is duly
enc edas
recui
byl
That,it is based upon stcctttto
,xY author
That it is apparently
in neck ,
. incorrect
_. On Account of Ap ropilation No. °.. f
llisbtrrsing Olflcer
An.th sum e of�
, N
-
_.
0 OH
olci*d or commission)
FILED N
(011lclal Tltle) .