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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