185337 05/11/2010 CITY OF CARMEL, INDIANA VENDOR: 362732 Page 1 of 1
ONE CIVIC SQUARE PAMELA LISTER
CARMEL, INDIANA 46032 CHECK AMOUNT: $45.50
11598 MANSFIELD PLACE
CARMEL IN 46032 CHECK NUMBER: 185337
CHECK DATE: 5/11/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343002 45.50 MILEAGE
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MILEAGE CLAIM
{GOVERNMENTAL UNIT) TO DR,
ON ACCOUNT OF APPROPRIATION NO. FO
(OFFICE. BOARD, DEPARTMENT OR INS71TUTION)
DATE FROM TO SPEEDOMETER j AUTO MILEAG
t9 READING+ I MILES ,T-� rr
P01N7 POINT 5TART FkNISN 'MATURE OF BUSINESS TRAVELED }TER MILE
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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. I hereby certify that the foregoing account is just and correct. that the amount clairn egQEY due. after QUOWing. all lust creel
and that no port of the sarne has been paid.
Data /✓�7
Claim No, Warrant No. I have examined -the wiftn.:claim and hereby
IN FAVOR OF
certify as follows:
That it is in proper form
PA M uS t �r That. it is duly authentic4ated as required
by law.
That -it is based upon statutory authority.
That it is apparently j incorrect
On Account of Appropriation No. /for Dis wising Officer
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in the sum of ,Q a
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