HomeMy WebLinkAbout173428 06/10/2009 CITY OF CARMEL, INDIANA VENDOR: 362732 Page 1 of 1
ONE CIVIC SQUARE PAMELA LISTER
0 CHECK AMOUNT: $53.90
CARMEL INDIANA 46032
11598 MANSFIELD PLACE
oN �o CARMEL IN 46032 CHECK NUMBER: 173428
CHECK DATE: 6/1012009
DEPAR ACCOUNT PO NU MBER INVOIC NUMBE AMO UNT DESCRI
1207 4343004 53.90 MILEAGE
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Prescribed by State Board of Accounts General Form No. 101 (1955)
�c MILEAGE CLAIM
TO r' I C, ,v��J mil YiO0 DR.
(Governmental Unit)
CS 6(p l- l LLb On Account of Appropriation No. for
(Office, Board, Department or Institution)
DATE FROM TO ODOMETER READING' NATURE OF BUSINESS AUTO MILES MILEAGE :5Y
20 Point Point Start Finish TRAVELED PER MILE
O clzse 3 l ii s�4
ao I P; 4-V A0,11 V 1 15.4,41 r� �t �r do
S d l t,? S-E 3,�Z 5&
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2
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66 V- X/ A6
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Auto License No. I 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
Clam No. Warrant No. I have examined the within claim and
hereby certify as follows:
IN AVOR OF
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 t correct
d incorrect
On Account of Appropriation No. for
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