248431 08/12/15 CITY OF CARMEL, INDIANA VENDOR: 362732
r ® ONE CIVIC SQUARE PAMELA LISTER CHECK AMOUNT: $********95.45
4 CARMEL, INDIANA 46032 11598 MANSFIELD PLACE CHECK NUMBER: 248431
CARMEL IN 46032 CHECK DATE: 08/12/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 95.45 TRAVEL PER DIEMS
MILEAGE C
escdb,d by stele Board of Accounts
'Yl ovemmenta LIN'
epertment or ns to on
TO ODONtETEP
DATE FROM Point
Point
20: / I 9
17 `� LA c1 5 - 96
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"A i ( ` L S
.'7 I 0 S�
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I
w
_.----- Auto License No.
-
TER READING columns are to be used only when distance between points cannot be da�temo
isions and pe
SPEEDOMETER certify that the foregoing
nalties of Chapter 155,Acts 1953, 1 hereb
Pursuant to the provy
allowing all just credits, and that no part of the same has been paid.
uenerai rorm no. _r ul (1955)
LAI M
SP A-e-u� i`-� DR.
On Account of Appropriation No. 430 'd for
READING* NATURE OF BUSINESS AUTO MILES MILEAGE @
Finish TRAVELED PER MILE
VL
oa
6?
IL
TOTALS
ned by fixed mileage or official highway map.
nt is just and correct,that the amount claimed is legally due,aft
Claim No. Warrant No. _ I have examined the within claiin and
hereby certify as follows;
IN FAVOR OF
That it is in proper form;
Ls`S-t 2 _ — That it is duly authenticated ccs requi
by law;
. That it is based upon statutory author
\ That it is apparently {correct
incorrect
On Account of Appropriation No.—_ for
Disbursing Officer
C�
Allowed !�0
b'
in the sum of$ 00
4-4
rom
N N
O
(Board or Commission)
FILED rn
Q
(Official Title)
m
0