HomeMy WebLinkAbout247378 07/15/15 +py C�q�
\F� CITY OF CARMEL, INDIANA VENDOR: 362732
` CHECKAMOUNT: $********81.01*
.I ® ��• ONE CIVIC SQUARE PAMELA LISTER
:\ �_�; CARMEL, INDIANA 46032 11598 MANSFIELD PLACE CHECK NUMBER: 247378
.yho,;c�. CARMEL IN 46032 CHECK DATE: 07/15/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 81.01 TRAVEL PER DIEMS
roscdbed by State Board of.AccountsM LEaGE G,LAI M
Wanera!Form No. 1 Oi(1955)
TO
(governmental nQ -------_DR•
�� On Account of Appropriation No. �rD-
�. O for
(office,Board,uspertmeift or institution
DATE FROM TO ODOMETER READING" NATURE OF BUSINESS AUTO MILES MILEAGE
yp � Poinf Point �finish G Y i TRAVELED PER MILE /a
0
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ct Lc - 3 A17.
S"&q(0& w. L.i 002
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Auto License No. TOTALS
* SPEEDOMETER READING columns are to be,used only when distance between points cannot be determined by fixed mileage or official highway map, j
..Pursuant to the prbvisions and penalties of Chapter 955,Acts 9953,1 hereby-certify that the foregoing account is just and correct,that the amount claimed Is legally dye,after
allowing ali just credits,and that no part of the same has been paid.
�_a� (9 -'36 ���
I
Claim No. Warrant No.
I have ex�ied the within cicdi-n;cmd
j.
1N FAVOROF hereby Certify as follows:
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That_it is in proper form;
That it is duly authenticated cm regal
....... ._....___._. _. _ _ .. by law,.
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. That it
horse pons tho�
appccxren j
i
That.it is tly, l correct
On
VAccount of Appropriaiori No,
Bi bsur�1ng Otflcer
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Allowed
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in the sum of$ cQ
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