HomeMy WebLinkAbout197287 05/11/2011 CITY OF CARMEL, INDIANA VENDOR: 362732 Page 1 of 1
0 ONE CIVIC SQUARE PAMELA LISTER CHECK AMOUNT: $61.71
CARMEL, INDIANA 46032 11598 MANSFIELD PLACE
CARMEL IN 46032 CHECK NUMBER: 197287
CHECK DATE: 5/11/2011
D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 REIMB 61.71 TRAVEL PER DIEMS
Prescribed by State Board of Accounts MILEAGE CLAIM General Form No. 101 (1955)
f
TO O X3 `�'t SS. I DR.
(Governmental nit)
On Account of Appropriation No. for
Office, Board, Department or Institution
DATE FROM TO ODOMETER READING" NATURE OF BUSINESS AUTO MILES MILEAGE
20 1 Point Point Start Finish TRAVELED PER MILE
�7 9(v a �SJ�� 5 7
LA G ell
300 /73 7
L 36 201 8 d 3
.ti u %_k. C111 Jo Jv /.W- 02 3
ti u vi 9 6 2 .0 ae2 V
U 30 0 asp K s
to ul k ✓1 o D S to 3
kA u 30 319 303 v �n
-i( w tA 30C/4 30YS L� 7
3 a 0 3,1 Y7
V1 vt 3
30 30 3
Auto License No. TOTALS o2
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
Clam 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 requi
by law;
That it is based upon statutory autho:
That it is apparently correct
4? 7� !G incorrect
On Account of Appropriation No. G for
Disbursing Officer
O,
Allowed 20
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in the sum of o
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(Board or Commission) I` i
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