HomeMy WebLinkAbout217420 02/13/2013 a CITY OF CARMEL, INDIANA VENDOR: 065950 Page 1 of 1
ONE CIVIC SQUARE DIANA CORDRAY
0I CHECK AMOUNT: $102.88
CARMEL, INDIANA 46032 11843 STONEY BAY CIRCLE
CARMEL IN 46033-9501 CHECK NUMBER: 217420
CHECK DATE: 2/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4343004 102 . 88 PARKING/MILEAGE
Prescribed by State Board of Accounts General Form No.101 (1955)
�J MILEAGE CLAIM
C-�t'4 01 �-P'�� TO DR.
(Governmental Unit)
0 f .� On Account of Appropriation No. for
(Office,Board, Department or Institution)
DATE FROM TO ODOMETER READING' NATURE OF BUSINESS AUTO MILES MILEAGE @ i S6S
20 13 Point Point Start Finish TRAVELED PER MILE
d1
1 e9Z (4
522* 7
Auto License No. t TOTALS /�� k
" SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. U
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. a
Date
Circle Centre Mall
Indianapolis, IN
Fee Computer Number: 6
Cashier: Id #176
Transaction Number: 54993
Entered: 02/04/2013 9:43
Exited: 02/04/2.013 11:31
Ticket 987625 Dispenser #39
Lot: Sun
Area: Area 1
Rate: Daily 2012 Rate
Parking Fee: $ 2.00
Total Fee: $ 2.00
Cash:
Iotal Paid:
Thank You
Denison Parking
Circle Centre Mall
Indianapolis, IN
Fee Computer Number: 6
Cashier: Id #175
Transaction Number: 60201
Entered: 02/13/201 07:58
Exited: 02/13/2013 09:39
Ticket #77664 Dis er #37
Lot: Sun
Area: Area 1
Rate: Daily 2012 Rate
Parking Fee: $ 2.00
Total Fee: $ 2.00
Cash: \
Total Paid: 2.00
Thank You
Denison Parking
Clam No. Warrant No. I have examined the within claim and
hereby certify as follows:
IN FAVO QFF�
��.J That it is in proper form;
That it is duly authenticated as required
by law;
That it is based upon statutory authority;
J That it is apparently correct
$ CG incorrect
On Account Appropriation No. for U f Disbursing Officer
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Allowed 20 (D o
in the sum of$
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(Board of Commission)
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