218927 04/09/2013 CITY OF CARMEL VENDOR: 362732
, INDIANA Page 1 of 1
ONE CIVIC SQUARE PAMELA LISTER CHECK AMOUNT: $38.94
�a CARMEL, INDIANA 46032 11598 MANSFIELD PLACE
CARMEL IN 46032 CHECK NUMBER: 218927
CHECK DATE: 4/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 38 . 94 TRAVEL PER DIEMS
Prescribed by State Board of Accounts General Form No.101(11355)
MILEAGE CLAIM n /
-TA,n Li To SP Governments nit) I
0 ��r On Account of Appropriation No. (4-3O 6 7 for II 11,
Office,Board,Department or institution)
DATE FROM TO ODOMETER READING` NATURE OF BUSINESS AUTO MILES MILEAGE @
20 Point Point Start Finish TRAVELED PER MILE
<9 1 \A
a5-a,4 �. � 3 95
. t
Auto License No. TOTALS
" SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155,Acts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after
allowing all just credits, and that no part of the same has been paid. "
Date )/-a��-1 _d. ;
Claim No. Warrant No. I have examined the within claim and
hereby certify as follows;
IN FAVOR OF
That it is in proper form;
?All L � `S�� That it is duly authenticated as reclui
by law;
That it is based upon statutory.autho:
corrct
_ . ... _
30`s 94 That it is apparently incorrect
On Account of Appropriation No.-Lki)-Oq for
- Disbursing Officer
Allowed — 20
_ in the sum of$ '��' / / - O
0
(Board or Commission)
FILED -
A
0
M
0
(Official Title)
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