182001 02/03/2010 CITY OF CARMEL, INDIANA VENDOR: 362732 Page 1 of 1
r.,;i ONE CIVIC SQUARE PAMELA LISTER
i
CARMEL INDIANA 46032 71598 MANSFIELD PLACE CHECK AMOUNT: $69.40
V.4 CARMEL IN 46032 CHECK NUMBER: 182001
CHECK DATE: 21312010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 69.40 MILEAGE
=r.
Prescribed by State Board of Accounts r te- General Form No. 101 (1955)
MILEAGE CLAIM
w. TO OP a e. i.3' 'c t, !A- r DR.
(Governmental Unit) u
4:7 '7 2GD/CS/I%,PQ &d a On Account of Appropriation No. for
(Office, Board, Department or Institution)
DATE FROM TO ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE S:
20 09 Point Point Start Finish TRAVELED PER MILE
/i //9 09 66/P err,/ sg- ei/y 1/ 59/is 5 .L 4 J. 65`
Q0 ,j/ .i. 5 eV' /3 .:z vl f1 /'r7AS C a r`6'._ 10
'q /9 I I ..P 1 IM r 1 3'
i Vn 4 ,osrea J /?a• Q% c&l /59/f 4S Y ,206 v`-- A ,qei j3 if )4. .5 a
/3d /a9 6 /P )1-.,es-e -1 :s92,?4 LS —0/9-i /y ;l ri`Z a aa
JO Q9 2/ a .•i• -o 02 6-'1...Z-4/ Gt g 6•5-
J.09 ..a .6 C 6- (?.,1-7 4 /S9aa( o- I.,( J
////-5/
,d,/ 9 c-r C; 1.7 s9,?/n4 4aV S (os
e f' 'IIIi 11 1 s III /s /5-5"/
s J' 7a i re Zr_ due- Aida" 1/112
,26 G l) (Z 7 S<
3 /s: 93V 7 l'� /i 54
1a 9 i loa .aaJe 4s9f 7 /S So l r 65' e• r• s .•6, c r ,,?0
jiff, 4 Mi Ii'J /�._P s� I /0 /�I �lI 6
s 0 �I •1111MAIM!. I 9 9 1 I Eri ll_
_a�1zo -d d�� I 1 k I( 1 3 1
/�/.2 /09 tea s& 3 9a' 99'1 LL 14 a
4 +tea -�4V (:o' l lfl n a. J s 5% 4 l r EIMIWt..5—
0A/ri 4 .au z
rdr I 9ss ar -s 1 L r, 1 ._9- I
j Q� oi/ s l'/ 1y -0 /2,4J I s4 S 3 7 o- ii 4 L -,o,� Z ��,ii/ ii. e I to 'z C' �I
d 9 6 I s 16 I ILi I
1 6 A I jJ d
1 i I /s9 ,z .x'794 1 1 J 1
Auto License No. TOTALS /0.72
I O.
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, I hereby certify that the foregoing account is just and correct, that the amount claimed is I y due, after
allowing all just credits, and that no part of the same has been paid. /9,
Date /54)9 ..h X77
Claim No. Warrant No I have examined the within claim and
hereby certify as follows:
IN FAVOR OF
That it is in proper form;
That it is duly authenticated as required
by law;
That it is based upon statutory authority;
L That it is apparently t c orrect
incorrect
On Account of Appropriation No. for
Disbursing Officer
C 6" N a
Allowed ,20
in the sum of o. R
o
r
m
o a 9 B
(Board or Commission) y
O
FILED m R. Q_
t
9
m
C c
TrZ/ 1) 14), l‘operiediukf
(Official Title)
O
cn
O O-