HomeMy WebLinkAbout212674 09/12/2012 CITY OF CARMEL, INDIANA VENDOR: 362732 Page 1 of 1
ONE CIVIC SQUARE PAMELA LISTER
CHECK AMOUNT: $89.24
;.ice l CARMEL, INDIANA 46032 11598 MANSFIELD PLACE
L o� CARMEL IN 46032 CHECK NUMBER: 212674
CHECK DATE: 9/12/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 89 . 24 TRAVEL PER DIEMS
Prescribed by State Board of Accounts General Form No.101 (1955)
MILEAGE CLAIM ,I
Al Yl TO F C _ n 0A-CLI 'a T, -' DR.
(Governmental nit)
On Account of Appropriation No. for�M l�l��r
Office,Board,Department or Institution)
DATE FROM TO ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE @ 5yf-4
20 A-2 Point Point Start Finish TRAVELED PER MILE
o - o D - 9/D. 1
_�;/ - oZ 1 t 1 t V z it a
rz
LA
11_ /! Ilt �! n wSr t l Gt
tK 9 �7'I :�. 3 9
P- u w 39.5-91 (L P7 3
a-,2142 t,L +� 5-Z 39 6 2 3 k
- d -Z.1 '7 sa r? 3
' I
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. I
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 c'r diit`s, and that no part of the same has been paid.
Date
Claim No. Warrant No, I hcrve examined the within claim ca-id
hereby certify as follows:
IN FAVOR OF
That if is in proper form;
That it is duly authenticated as requi
bylaw;
_ - That it is based upon:statutory autho:
_.`' ' - • ~ - •
{correc
hat it is appcvently, incorrect
o?
On Account nt of Appropriation No.� y� for
Disbursing Officer
- - -
Q 10
Allowed 20 - -
_ in the sum of
(D a�
�.(D
(D
- C)
(Board or Conunission) •"
C
FILED
R
o
(oiflcic d Tiue) Q
ti