HomeMy WebLinkAbout245901 06/03/15 ��..�,q+. CITY OF CARMEL, INDIANA VENDOR: 362732
ONE CIVIC SQUARE PAMELA LISTER CHECK AMOUNT: $********72.95*
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CARMEL, INDIANA 46032 11598 MANSFIELD PLACE CHECK NUMBER: 245901
9•y��TpN ,; CARMEL IN 46032 CHECK DATE: 06/03/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 72,95 TRAVEL PER DIEMS
oscdbed by Stale Board of Accounts MILEAGE CLAIM -
ueneral Form No, 101(I IMS)
' TO
ovemmenta nt aR.
On Account of Appropriation No.
twulue,Boar ,..apartment or Instto on
DATE FROM TO ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE �r
20
Point Point Start Finish TRAVELED PER MILE 7/
a �— 5 f5rTE61,
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r C X 5(04 5"r it J
.Acc 5'S 30 S7 3 v
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Auto License No. 1 TOTALS
* SPEEDOMETER READING columns are to be used only when distance between points cannot be deterrnlned by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155,Acts 1953;1 certify that the foregoing account is just and correct,that the amount clai fly due,after
allowing all just credits,and that no part of the same has been paid.
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Claim No. Warrant No, I have examined the within clahm.and
hereby Certify as follows:
IN FAVOR OF
That it is in proper form;
That it is duly authenticated as requi
That it is based upon statutory author
en
. correct..
That itis appca dy incorrect
On Account of_A
pproprfcttion No, U _I&
_. _. _ � Disburslrig"018cer - -
Ir Q
Allowed X20 ( _
in the sum of$ / JD
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(Boa rd'or CommhrJon) I!
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