HomeMy WebLinkAbout253128 01/11/16 y�r C�q3
�✓ CITY OF CARMEL, INDIANA VENDOR: 362732
ii ® 1' ONE CIVIC SQUARE PAMELA LISTER CHECK AMOUNT: $ra►.•`r}32.16•
s• ,_�, CARMEL, INDIANA 46032 11598 MANSFIELD PLACE CHECK NUMBER: 253128
9'',«oN�. CARMEL IN 46032 CHECK DATE: 01/11/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 MILEAGE 32.16 TRAVEL PER DIEMS
-escdbed by State Board of-Accounts
MILEAGE CLAIM
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On Account of Appropriation No. Q
0 ce,Board, epattrr jit or ns to on
DATE FROM TO" ODOMETER READING* t
20 Point Point Start Finish NATURE OF BUSINESS
17
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1.OTALS j
" SPEEDOMETER READING columns are to be used only when distance between points cannot be deterrnined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155,Acts 195311 hereby certify that the foregoing account is just and correct,that the arnounf claimed Is legally d�e,after
allowing all just credits,and that no part of the same has been paid. ,
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I have examined the within Claim and.
Claim No. wcaxant No.. certify as follows;
} IN FAVOR OF
That it is in proper form;
_ That it is duly authenticated as requi:
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( That it is based upon statutory author
i , That tt is apparently. correct
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On Account of Appropriaiian No. 14 3e5-6 for .
Mburs
ing 0t8cer
Mowed X20:____-�
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ty
in the sum of$
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(nocact or Commission)
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