HomeMy WebLinkAbout226737 12/03/2013 CITY OF CARMEL, INDIANA VENDOR: 362732 Page 1 of 1
ONE CIVIC SQUARE PAMELA LISTER
CARMEL, INDIANA 46032 11598 MANSFIELD PLACE CHECK AMOUNT: $51.35
??' CARMEL IN 46032 CHECK NUMBER: 226737
«ON t0'
CHECK DATE: 1213/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 51 . 35 TRAVEL PER DIEMS
Prescribed by Stale Board of Accounts General Form No,101 (1955)
MILEAGE CLAIM
y t TO A-C DR.
2 (Governments nit Sg
On Account of Appropriation No. -CS for
lyttiCeVIElDard,Department or Institution)
DATE � "FROM TO
ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE
. 20/ Point Point Start Finish TRAVELED PER MILE
q1,607
t t \k- it q G 6 10
o a " ` 3 9-
CJ 9
\� L c Cc S7 t{(/ �
_ r g5
In t t ct X35 17a 1
J It l� CI 4l' Lt
QS
t l \\ t " 411, .. % (-,
F, r, -, 9
l
Auto License No. TOTALS
* SPE=EDOMETER 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 due, after
allowing all just credits, and that no part of the same has been paid.
Date 2
Claim No. Warrant No._ — I have examined the within claiin and
hereby certify as follows:
IN FAVOR OF
That it is in proper form;
That it is duly
authenticated as requi:
by law;
That it is based upon'statU.tory author
f
That i t is apparently ;
l coec
tt
C orr
_ On Account of Appropriation No.-.Q�-y�_for
_._
_ -. _ d •Disbttrsirig Officer
O
Allowed' ,20 n
_ - in the sum of ��� �2 o ,
_
- CCD
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(Board on
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