HomeMy WebLinkAbout200523 08/17/2011 CITY OF CARMEL, INDIANA VENDOR: 362732 Page 1 of 1
f ONE CIVIC SQUARE PAMELA LISTER CHECK AMOUNT: $68.26
CARMEL, INDIANA 46032 11598 MANSFIELD PLACE
o: CARMEL IN 46032 CHECK NUMBER: 200523
CHECK DATE: 8/17/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 REIMB 68.26 TRAVEL PER DIEMS
Prescribed by Stale Board of Accounts MILEAGE CLAIM General Form No. 101 (1955)
TO DR.
(Governmental nit)
On Account of Appropriation No, for
(Office, Board, Department or Institution
DATE FROM TO ODOMETER READING* NATURE OF BUSINESS =AE MILEAGE 20)/ Point Point Start Finish PER 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, 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
i
Claim 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
a(p incorrect
On Account of Appropriation No. for
Disbursing Officer
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