HomeMy WebLinkAbout252041 1 2/02/1 5 (9,
CITY OF CARMEL, INDIANA VENDOR: 362732
ONE CIVIC SQUARE PAMELA LISTER CHECK AMOUNT: $********91.38*CARMEL, INDIANA 46032 11598 MANSFIELD PLACE CHECK NUMBER: 252041
CARMEL IN 46032 CHECK DATE: 12/02/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 91.38 TRAVEL PER DIEMS
ueneral Form No.101 (1955)
MILEAGE CIT
,escribW by Slate Board of Accounts _
To R.
'Yl Govemmenta n [L �L �
On Account of Appropriation No. Zr3 '�-7 for ICIP4izL
/ - ce,
oa epertmentor ns lu on I ---
TO ODOMETER READING" NATURE OF BUSINESS AUTO MILES MILEAGE
DATE FROM Start Finish TRAVELED I PER MILE 7 a
Point b Q
Point - '
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20 S GS-l�r� �J D �
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TOTALS
Auto License No.
columns are to be y rnap.
used only when distance between points cannot be determined by fixed mileage or official the amiou tecta claimed i (ly due,after
SPE=EDOMETER READINGaccount is just and correct,that
rovisions and penalties of Chapter 155,Acts 1953, I hereby certify that the foregoing
Pursuant to thep
allowing all just credits, and that no part of the same has been paid. �� "
Claim No. Warrant No. — I have examiized the within claim and
.
hereby certify as follows;
c�
IN FAVOR OF
uL That it is in proper form;
. =_" •"%,. That it is
d auth ed
ccs requi
...per
by
law;
That it is based upon statutory author
correct
. That it is apparently l
��/ incorrect
$
On Account of Appropriation No. for
.:; Disbursing officer
';
•��� �% Allowed
' in the sum of$ r
cia
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F (Board or Commission) I U
r
FILED i to
' (011iclod Title)