HomeMy WebLinkAbout228195 1/15/2014 CITY OF CARMEL, INDIANA VENDOR: 362732 Page 1 of 1
ONE CIVIC SQUARE PAMELA LISTER CHECK AMOUNT: $15.82
CARMEL, INDIANA 46032 11598 MANSFIELD PLACE
CARMEL IN 46032 CHECK NUMBER: 228195
CHECK DATE: 1/15/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 15 . 82 TRAVEL PER DIEMS
Prescribed by Slate Board of Accounts General Form No,101(1955)
MILEAGE CLAIM
Y1 TO
Go�DeDartMl
vernmenta nit G
.� � On Account of Appropriation No. 6 _d for , lrOff ce, Mk
nt or Institution
DATE FROM TO ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE
20 Point Point Start Finish TRAVELED PER MILE
77
r�
Autolicense No. TOTALS
* SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155,Acts 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after
allowing all just
credits, and that no part of the same has been paid.
Date
1
Claim No. Warrant No. I have examined the within claim and
hereby certify as follows:
IN FAVOR OF '
That it is in proper form;
That it is duly authenticated as requi
by law;
That it is based upon statutory,autho:
That it is apparently correct
incorrect
On Account of Appropriation No. for
-Disbursing:officer
Y 10.
Allowed
_. in the sum of$ l S o coq
Cv -
(D
N ((D
(Board or Commission) �e
,
FILED m
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