HomeMy WebLinkAbout170481 04/01/2009 a CITY OF CARMEL, INDIANA VENDOR: 362732 Page 1 of 1
ONE CIVIC SQUARE PAMELA LISTER
CARMEL, INDIANA 46032 11596 MANSFIELD PLACE CHECK AMOUNT: $43.45
CARMEL IN 46032
CHECK NUMBER: 170481
CHECK DATE: 4/1/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343002 43.45 MILEAGE
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Prescribed by State Board of Accounts General Form No. 101 (1955)
MILEAGE CLAIM
Plzn L Tb TO j �1G4�� (`)tJQi aJ10- �C DR.
(Governmental Unit)
1 7es:b E{i P-� On Account of Appropriation No. for
(Office, Board, Department or Institution)
DATE FROM TO ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE @,f;�4,
20 O y Point Point Start Finish TRAVELED PER MILE
i c4- l 5 1 S F S
o �-p 0 IIZ7 spa 5 I t 3 s
-i p 6 33 yam 3 34�so a o
-/3 1-14 c Cs -1 t�se r e�� S ass a oZ 75
Sss7� /5S G S
3 -cqi 0�4 3 s
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 just credits, and that no part of the same has been paid. y
3
Date
Claim No. Warrant No, I have examined the within claim and
hereby certify as follows:
N FAVO OF
5 i
S I 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 correct
3, incorrect
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