HomeMy WebLinkAbout174597 07/15/2009 CITY OF CARMEL, INDIANA VENDOR: 362732 Page 1 of 1
ONE CIVIC SQUARE PAMELA LISTER CHECK AMOUNT: $59.95
CARMEL, INDIANA 46032 11598 MANSFIELD PLACE
CARMEL IN 46032 CHECK NUMBER: 174597
CHECK DATE: 7/15/2009
DEPA RTMENT ACCOUNT PO N UMBE R INVOIC NUM BER AMOUNT DESCR IPTION
1207 T 4343004 59.95 TRAVEL PER DIEMS
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Prescribed by State Board of Accounts
General Form No. 101 (1955)
MILEAGE CLAIM
TO C
DR.
(Governmental Unit)
Z2L ��2C�dl�S� 1 P� 1 l J� 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
0
1 52,” /S
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a 9 �D
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Auto License No.
TOTALS S 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 claimed is legally due, after
allowing all just cre dits, pn ddj that no part of the same has been paid.
n�f- /.�yl17 6�1
Claim No. Warrant No. I have examined the within claim and
hereby certify as follows:
IN FAVOR OF
?0 That it is in proper form;
Y 1 1 j� That it is duly authenticated as required
by law;
That it is based upon statutory authority;
That it is apparently correct
incorrect
On Account of Appropriation No. I d— for
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Allowed
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(Board or Commission)
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