HomeMy WebLinkAbout199097 07/06/2011 CITY OF CARMEL, INDIANA VENDOR: 362732 Page 1 of 1
ONE CIVIC SQUARE PAMELA LISTER
CARMEL, INDIANA 46032 11598 MANSFIELD PLACE CHECK AMOUNT: $157.08
CARMEL IN 46032
CHECK NUMBER: 199097
CHECK DATE: 7/6/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 157.08 TRAVEL PER DIEMS
Prescribed by Slate Board of Accounts MILEAGE CLAIM General Form No. 101 (1955)
TO DR.
(Governmental nik}
2
1,26�jC` F l On Account of Appropriation No, for
(Office, or Institution
DATE FROM T O ODOMETER READ{NG" NATURE OF BUSINESS AUTO MILES MILEAGE
20 Point Point Start Finish TRAVELED PER MILE
75; ME
LJ
if S-
t v�
u
Ut t t t 3 3 Ir 3 'Al
v! t 1 tti t f C
vt 3 %a /GZ c t vt
0 L& 11 7 i -L 7 1 N G S
Auto License No. TOTALS s
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 claime egally due, er
allowing all just credits, and that no part of the same has been paid. i
Date
C1C= No. Warrant No. I have excarnuZed the within claim ca
hereby certify as follows:
IN FAVOR OF
That it is in proper form;
That it is duly authenticated as requi
by law;
i
That it is based upon statutory autho:
That it is apparently
incorrect
On Accow of Appropriation No. On
Disbursing Officer
cq 1 0
O
Allowed 20
in the sum of o
n
`Cn }nj
r F
V (D
r-k-
N (D
O
(Bowd or Commission)
FILED CD
I
I
O
O
r«
(Otficiod Title)
rr
(D
O
Prescribed by Slate Board of Accounts MILEAGE CLAIM General Form No, 101 (1955)
TO DR.
{Governmental Unit)
On Account of Appropriation No.
Office, Board, Department or Institution) i
DATE FROM TO ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE
20 Point Point Start Finish TRAVELED PER MILE
Liu s C�
c 0 41 LA c 3
3/& 5` ti vt 3 7
a3 o 3 s Z_ �d
i i I J12 Q i 3 s7
1 ,7 5 7
d Q
Auto License No. J TOTALS P f
i
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 i ly due, after
allowing all just credits, and that no part of the same has been paid.
Date
Claim No. Warrant No. I have examined the within claim ca
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 author
1 0 9 That it is appar correct
ently incorrect
•a On Accoiuit of Appropriation No. for
Disbursing Officer
i
Allowed 20 CD
in the sum of if o
o
(D
r,-
H
Q l�
(Board or Conunission)
G
FILED
I
i
i
C)
(Official Title)
r,-
(D
O