HomeMy WebLinkAbout179755 11/24/2009 CITY OF CARMEL, INDIANA VENDOR: 362732 Page 1 of 1
ONE CIVIC SQUARE PAMELA LISTER
CARMEL, INDIANA 46032 11598 MANSFIELD PLACE CHECK AMOUNT: $64.35
CARMEL IN 46032
CHECK NUMBER: 179755
CHECK DATE: 11/24/2009
7EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
Ll
1207 4343004 64.35 TRAVEL PER DIEMS
Prescribed by State Board of Accounts
General Form No. 101 (1955)
.�7 MILEAGE CLAM
TO DR.
(Governmental Unit)
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 S" �q (Yl',L /L/A f sue 3
1 �U U C 9 /s V (r 3 s
141 1 (2 1 1 4 4/0 7 ft.1�� //y/ L3 kk
.P ofd
-T l mil. 5
ZIP -A,)�e cam 3 psi rt s8 S'A 2 L E gib /7 f
Ile) /ai 09 1 A&'// /rrs41 s 7 3 (v S
/a4x S"QG s8G 7fi t i
A41 '21 Inel. 'F
a9 Cd l 4? oju ec4 24 _/_Y A /sue o k 20 7 1 1 3 /vS
9 %s'f d 3 l�S
h Q 9
r� r� �'aKs� 3 w s �su�
13 /X 0-1011leC9 .ir 9/ Sikt> 'y
09 9 2 s�f' /J g -re"a
S" 3 7 \k
1114 4 lir rO" /38 90 l G S
o C�1; AWI
Auto License"No. TOTALS 4 1 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 i ally due, after
allowing all ju t 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 fcllows:
IN FAVOR OF
1�1 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
b4 r j incorrect
On Account of Appropriation No. for
Disb.using Officer
�W p
(D
Allowed 20 o
0
in the sum of T o
G Q (D
'd
m
(Board or Commission) 0 00
FILED o
m
n CD
o
m
(Official Title) j
1. r. r,
M O
0 C(D