HomeMy WebLinkAbout204755 12/20/2011 CITY OF CARMEL, INDIANA VENDOR: 065950 Page 1 of 1
ONE CIVIC SQUARE DIANA CORDRAY
CARMEL, INDIANA 46032 11843 STONEY BAY CIRCLE CHECK AMOUNT: $258.74
CARMEL IN 46033 -9501 CHECK NUMBER: 204755
CHECK DATE: 12/20/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4343004 REIMB 258.74 TRAVEL PER DIEMS
Circle Centre Mall
Fee Computer MUlllbef•: 4
Cashier: Tesfay F. Id #147
Transaction IM111ber: 347827
Entered: 12/14/2011 11:40
Exited: 12 /14/2011 15:00
Ticket #14393 Dispenser #37
Lot: Sun
Area: Area 1
Rate: Sleli rd Rate
Parking Fee: T 1.00
Total Fee: 4.00
Cash: 4.00
Total Paid: 4.00
Thank You
Denison Parking
I
Prescribed by State Board of Accounts General Form No. 101 (1955)
0 MILEAGE CLAIM
TO DR.
Gover ntal Unit)
On Account of Appropriation No. for
(Office, Board, Department or Institution)
DATE FROM TO ODOMETER READING' NATURE OF BUSINESS AUTO MILES MILEAGE
2 Point Point- Start Finish TRAVELED PER MILE
71011 1
T— El p -:2-7SO
r n'd'P a tab
d yr c�1
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 ju credits, and that no part of the same has been paid. �L e
Date
Clcdm No, Warrant No. I have examined the within claim and
hereby certify as follows:
N FAVOR OF
1 That it is in proper form;
That it is duly authenticated as required
by law;
That it is based upon statutory authority;
That it is apparently incorrect
4 On Account of Appropriation No. L7 for
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Allowed 20 o
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