224015 09/10/2013 CITY OF CARMEL, INDIANA VENDOR: 362732 Page 1 of 1
ONE CIVIC SQUARE PAMELA LISTER CHECK AMOUNT: $52.53
s` CARMEL, INDIANA 46032 11598 MANSFIELD PLACE
eaa� CARMELIN'46032 CHECK NUMBER: 224015
CHECK DATE: 9/10/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 52 . 53 TRAVEL PER DIEMS
I
Proscribed by State Board of Accounts Mp® E A GE CLAIM
General Form No.101(1955)
Tpr, TO �rrJi✓ n iV61 n flee u�X T�-' DR.
(Govern nit) �,
On Account of Appropriation No. 4,36 -6 for
O c9,Board, epartment or nstitut on
DATE FROM TO ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE @.
:.-2 Point Point Start I Finish TRAVELED PER MILE
Lf 4(,S.'o
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r I t /f
9 9s-
A
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c� „� �( ( cl aj
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N\ r 1 6 p 5
Auto License No. TOTALS
* SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155,Acts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount c77M
allowing all just credits, and that no part of the same has been paid.
Date �' '�� �
Claim No. Warrant No. 1 have examined the within claim card
hereby certify as follows:
IN FAVOR OF.
That it is in proper form;
'mom ' S-C That it is duly authenticated as requi
by law;
That.it is based upon statutory author
r correct
That it is apparently• fincorrect
On Account of Appropriation Na_q- -b for -
Disbursing Officer
(Q 10.
Allowed 20 m
in the sum of$ ?�.li �( o �i
CD
N
- N (D
C)
- (Board or Commission)
FILED M
(Official Title)
(D
P,