HomeMy WebLinkAbout201306 09/13/2011 *f CITY OF CARMEL, INDIANA VENDOR: 362732 Page 1 of 1
ONE CIVIC SQUARE PAMELA LISTER CHECK AMOUNT: $104.90
CARMEL, INDIANA 46032 11598 MANSFIELD PLACE
CARMEL IN 46032 CHECK NUMBER: 201306
CHECK DATE: 9/13/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 REIMB 104.90 TRAVEL PER DIEMS
Prescribed by Slate Board of Accounts MILEAGE CLAI General Form No. 101 (1955)
4��g— TO �i (J r� A DR.
(Governmental Unit)
U
On Account of Appropriation No. for
(Office, oar epartment or Institution
DATE FROM TO ODOMETER READING" NATURE OF BUSINESS AUTO MILES MILEAGE S
20 Point Point Start Finish TRAVELED PER MILE
1041// 5
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q 3 09
d 3 0
s ak 3 1�
LA— k9
V1_
a 0- vL a 3a moo? IL �1
13 1s n 3� k
.a o 19 33v v\ '7 3
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
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:
I
That it is apparently correct
incorrect
On AccotuZt of Appropriation No.
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Disbursing Officer
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in the sum of o ri-
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