188898 08/18/2010 CITY OF CARMEL, INDIANA VENDOR: 362732 Page 1 of 1
ONE CIVIC SQUARE PAMELA LISTER
CARMEL, INDIANA 46032 11598 MANSFIELD PLACE CHECK AMOUNT: $66.50
CARMEL IN 46032
CHECK NUMBER: 168898
CHECK DATE: 8/1812010
DEPARTMENT ACCOUNT PO NUMBER IN VOICE NUMBER AMOUNT DE SCRIPTION
1207 4343004 66.50 MILEAGE
pv. ib.d by St-t- Hoard of A.%"=t.. ,.ea.t al Forrs No. (Ol (1
r,
�M lei MILEAGE CLAIM
(GOVERNMENTAL UNIT) TO
C) DR.
1 67
�c�rp�C: ON ACCOUNT OF APPROPRIATION NO. FO
(OFFICE. BOARD. DEPARTMENT OR INSTITUTION)
DATE FROM I SPEEDOMETER I AUTO MILEAG
MILES
TO� READING+ p
POINT POINT NATURE OF BUSINESS 1 TRAVELED PER MILE
START FINISF'
i a it
�v
/v
,a v c t Da
v �r z�r�s ,.z� 9 I �L I
d dex Wit✓ I 1 -4 �t
'7 /emu s So? l S c c
p
0 /d
�9G�
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. Greer'
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 claim legally du aher allowin4. all just
and that no part of the same has been paid.
Date
Ciairn No. Warrant No. I have examined -the within -claim and. hereby
IN FAVOR OF certify as follows:
That it is in proper form.
That. it is -duly authenticated as required
by .law.
That -it is based upon statutory authority.
'What it is apparently t correct
incorrect
On Account of Appropriation No, for Dis ursing Officer
Cn
Allowed 19 5
G
in the sum of
o E.
OF
CD a
G Q 0�
(Board or Commission) Q
v CCD Q
b a
fl 0 0
FILED .o 0,0
C
(Official Title)
5' c
o
a ::r
CD CD
A.E. B01C( CO.. MUNCIE, IND. 06)70