HomeMy WebLinkAbout250330 10/07/15 .Coq .
`� CITY OF CARMEL, INDIANA VENDOR: 362732
® i1 ONE CIVIC SQUARE PAMELA LISTER CHECK AMOUNT: S"""""83.28`
i., ,ice CARMEL, INDIANA 46032 11598 MANSFIELD PLACE CHECK NUMBER: 250330
'M,�_aN�. CARMEL IN 46032 CHECK DATE: 10/07/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 83.28 TRAVEL PER DIEMS
tweneral Form No. 1 of (I 95s)
Slate Board or aco�n16 MILEAGE CLAIM
roscdbed by Tp —(� D R.
'Ylovernmentan t
On Account of Appropriation No. 4yy��3o-d for ��wg4lr
ce, oar , epartment or ns to on
TO ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE @
DATE FROM point Start Finish TRAVELED PER MILES' / ,
Point J, 6
20 _ U'/ �� , c 7
\
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w t
-45 3 0 5-
'
0
/ %1 L` • C1 ✓/ a
``_ v� `a-- "` — 'S o s �i ►t �l O
TOTALS %
Auto License No.
columns are to be used only when distance between points cannot be determined by fixed mileage or officialmiountaclaiap is all due aft
* SPEEDOMETER READINGaccount is just and correct,that thea Y
Pursuant to the p
rovisions and penalties of Chapter 155,Acts 1953, 1 hereby certify that the foregoing 1 _
allowing all Just credits, and that no part of the same has been paid.
J
Claim No. Warrant No. _ I have exanlined the within clailm and
hereby certify as follows;
IN FAVOR OF
That it is in proper form;
Thatit is duly authenticated ccs requi:
bylaw;
- — That it is based upon statutory author
That it is apparently I
Correct
incorrect
$
On Account of Appropriation No.-t VY for
Disbursing Officer
Allowed 20
C� tr
in the sum of$ rt' o '
i,2n/?
(Lon �
b �
N
(Board or Commission)
FILED
(Oillclul Title)
l�D
N