HomeMy WebLinkAbout178767 10/28/2009 CITY OF CARMEL, INDIANA VENDOR: 362732 Page 1 of 1
ONE CIVIC SQUARE PAMELA LISTER CHECK AMOUNT: $47.30
CARMEL, INDIANA 46032 11598 MANSFIELD PLACE
CARMEL IN 46032 CHECK NUMBER: 178767
CHECK DATE: 10/28/2009
DEPARTMENT ACCOUNT P O NUMBER INVOIC NUM BER AMOUNT DESCRIPTION
1207 4343004 REIMB 47.30 TRAVEL PER DIEMS
M
Prescribed by State Board of Accounts General Form No. 101 (1955)
MILEAGE CLAIM
1.20 7 -S r-` TO cl f jf DR.
(Governmental Unit)
/o On Account of Appropriation No. for
(Office, Board, Department or Institution)
DATE FROM TO ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE
201j_9 Point Point Start Finish TRAVELED PER MILE
6 ICAP .A 4s� C 7 9 P3 is Q; l ��.'f 12
;r'l�'�
2 2 a /l z
7 /lo �rS 1 1, L� l i1 1
jA Y4 -7/ a. <:Sol-P a Y3 s o-1 25"
'al Id -P Lo 'C 6 a -n) s o 'e3 L t 3 S
9/,z/ Ga/ �a AA4"O /.4' Dlo i sk/o
6G42 A/� v b
11SW71 /J8 7
s8 19 .a.a /v Q0 r�
1-4r 6
D a u.�[ s r �(i A W /.5W Y /;L' 1° S.
1 6 1 1109 e Gu n8
!o a /-J 339 6'
s A-2se A4 s` 3G 3 1 s
Auto License No. TOTALS �J
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 Acts 1953, 1 hereby certify that the foregoing account is just and correct that the amount clai is le ally dtie, after
allowing all just credits, and that no part of the same has been paid.
Date /D .���%u✓
�s
Claim No. Warrant No. I have examined the within claim and
hereby certify as fcllows:
IN FAVOR 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 incorrect
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On Account of Appropriation No. for
Disb.rrsing Officer
Allowed 20 o
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(Board or Commission) I
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FILED
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