HomeMy WebLinkAbout171924 04/29/2009 CITY OF CARMEL, INDIANA VENDOR: 362732 Page 1 of 1
ONE CIVIC SQUARE PAMELA LISTER CHECK AMOUNT: $61.60
CARMEL, INDIANA 46032 11698 MANSFIELD PLACE
s� CARMEL IN 46032 CHECK NUMBER: 171924
CHECK DATE: 4/29/2009
DEPARTMENT ACCOUNT PO NUMBER INV NUMBER AMOUNT DESCRIPTION
1701 4343004 61.60 MILEAGE
R
Prescribed by State Board of Accounts General Form No. 101 (1955)
MILEAGE CLAIM
TO Ito lA 1 DR.
((3overnmenta nit)
On Account of Appropriation No. for
(Office, Board, ep� artment or Institution)
DATE FROM TO ODOMETER READING" NATURE OF BUSINESS, AUTO MILES MILEAGE 1
20 41 3 Point Point Start Finish TRAVELED PER MILE
30 ccr2S� 5' s Alvil
2.2 .O CS :.u2S c .7. 3 7
z C G ours L'' i :SS9 -7'a6
vl n G
1 6q 7-5 1--
nn C 11
6 u i e /)'I/ 6 aS i L 2 6
7f us' c" s. G -a
Qo/ i 5�.� 7 .a o
rl am s l 3 <-196 3 dro
o 'r c A 5/4" I a 3 d'o't
a s.` 5"
(�Cr 7 k'S U �ia-T/ 6 c> /5�� 2 L 5' ±r 4
tt 3 36 l
411.2- 31a 65'.
1 3 s f 3
9 0l 7�" i3�9 a
/s( 6 3o A' o 2 a6
(o u G036 /S(G� 3 3 S.
Auto License No. TOTALS (7
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 FA OR OF
That it is in proper form;
That it is duly authenticated as required
by law;
That it is based upon statutory authority;
l� That it is apparently correct
uuu 1 d incorrect
On Account of Appropri on No. for
Disbursing Officer
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