189421 08/31/2010 CITY OF CARMEL, INDIANA VENDOR: 362732 Page 1 of 1
0 ONE CIVIC SQUARE PAMELA LISTER CHECK AMOUNT: $59.00
CARMEL, INDIANA 46032 11598 MANSFIELD PLACE
CARMEL IN 46032 CHECK NUMBER: 189421
CHECK DATE: 8/31/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 59.00 MILEAGE
ho,cli by 9tai. Boa rd of Moantnu. Eorm Mo. !Ol U.t�t
M I M
MILEAGE CL-AIM
(GOVERNMENTAL KNIT) TO DR.
ON ACCOUNT OF APPROPRIATION NO. FO
(OFFICE. e0ARD. DEPARTMENT OR INSTITUTION)
DATE FROM TO I SPEEDOMETER AUTO MILEAGE
READING+ MILES
�U POINT NATURE OF BUSINESS TRAVELED PER MILE
POINT START FINISH
oT d'�Iii�'f DlJ L a7
Iv
CL IF I 50-
v
v
res ;;rte
r IiS D s 4 c;�..
Q �s 3 a s i3 I -5-0 I I 3 I sd
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3 Sa
3 mod.
a g lge hLq
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AUTO LICENSE NO. TOTALS
+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 1953. 1 hereby certify that the foregoing account is just and correct, that the anount cl legally due. after allowing all just cred
and that no part of the same has been paid.
Date ZL-
rn No. Warrant No. i have examined the wittn_ claim and.ereby
IN FAVOR OF certify as follows:
That it is in proper form
u
That. it is -duly authenticated as required
bylaw.
T hat it is based upon statutory authority.
That it is apparenfiy t correct
incorrect
co
On Account of Appropriation No A 7 for Disbursing Officer
cps
Q o.. n
S o o
Allowed 19 y
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in the sum of s Q
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o a.
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(Board or Commission) Q x CD C)
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(Official Title) m
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