HomeMy WebLinkAbout176330 08/19/2009 a- CITY OF CARMEL, INDIANA VENDOR: 362732 Page 1 of 1
ONE CIVIC SQUARE PAMELA LISTER
+o CARMEL, INDIANA 46032 11598 MANSFIELD PLACE CHECK AMOUNT: $55.55
CARMEL IN 46032
CHECK NUMBER: 176330
CHECK DATE: 8/19/2009
_D EPARTMENT AC COUNT PO NUMBER IN NUMBER AMO UNT DESCRIPTION
1207 4343004 REIMB 55.55 TRAVEL PER DIEMS
Prescribed by State Board of Accounts M ILEAGE CLA
General Form No. 101 (1955)
M C
ILEAGE LAIM
TO au'e C iul�' SP �/�/2L' DR.
(Governmental Unit)
1,.,>20'? On Account of Appropriation No. for
(Office, Board, Department or Institution)
DATE FROM TO ODOMETER READING" NATURE OF BUSINESS AUTO MILES MILEAGE
20 Point Point Start Finish TRAVELED PER MILE
D �a�ic�GeE Ca►'�( �'�1N h/ /s'IQ S7 o5/ ;lu FAVSi�' .!r'�x- d
9&U i 4LP '�r7 0 vl" 's e5 T
Q9 !�?/46 Z-5 0 /a 7a '7dz
//'/c. i/ra /'7/03 /.57 �G
a 26
'1
l 'Iy A d/
7 19 109 ,4 J260 6 WE C/wh J' 0 `7/ qtr
/S d d 6K51 6 J 6 Z4.// -�'l�� is7.�S�� I t Y' o
M.4
'111G169 ov.CSlfi%CE (-0015f- //`4'v /'i -1A Xf T3F Z 5 7.Z76
'7 /'7 u' /r i sue ,ry/ 9•v5� l i a /0 5
711-71o9l 64 1 3 9'1 tti t 1 4 d0
09 6/ vui2 sue' Q A.<, L&q, it '136dr' /S 30
o u� Sc /S73'i.Z 73'
l_ a es� l?� v A61-// 33o S 33 k a �D
as o o� C?a u IsI33�9' 11 J �f
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a3 0 0 7 7
ear g' 1 'kv IV 7/5 .20
'7 a 'Z ate` /S -'3a� S S
Auto License No. TOTALS Ss .1.r
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;, F 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:
N
OR 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
incorrect
On Account of Appropriation No. for
�7 �r�Y• I_ j�t -1 Disbursing Officer
O
Allowed 20
in the sum of o
i
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m
o 1m
0
(Board or Commission)
FILED O
rn
R
0
0
c�
O
5
1 f s Cn
(Official Title)
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