334444 01/18/19 CITY OF CARMEL, INDIANA VENDOR: 364842
® i• ONE CIVIC SQUARE KATHLEEN VASIL CHECK MOUNT: $********13.92*
*e tea' CARMEL, INDIANA 46032 3779 SIMMERMAN CT CHECK NUMBER: 334444
.q��roN�, CARMEL IN 46033 CHECK DATE: 01/18/19
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT I DESCRIPTION
1207 4343004 13.92 TRAVEL PER DIEMS
Prescribed by State Board of Accounts ^
MILEAGE CLAIM
TO - r Oo�S�y C- Go� �S
(Governmenta nit)
I aD'] On Account of Appropriation No.
O ice,Board,Department or Institution
DATE FROM TO
ODOMETER READING* NATURE OF BUSINESS Al
20_18 Point Point start Finish— S
5;] Z 15,171D51
rookstn� 7�I �
�I
!
I
f
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.
Pursuant to the provisions and penalties of Chapter 155,Acts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after
allowing all just credits, and that no part of the same has been paid.
Date
i