HomeMy WebLinkAbout234027 06/25/14 a..e�q
''f� CITY OF CARMEL, INDIANA VENDOR: 358411
�. CHECK AMOUNT: $*******216.16*
ONE CIVIC SQUARE JENNIFER HAMMONS
:, �' CARMEL, INDIANA 46032 634 NORTHVIEW AVENUE CHECK NUMBER: 234027
.+. `TON�� INDIANAPOLIS IN 46220 CHECK DATE: 06/25/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 216.16 TRAVEL FEES & EXPENSE
777 Amk
PRESCRIBED BY STATE HOARD OF ACCOUNTS GENERAL FORM 110.101(1005)
MILEAGE CLAIM
CcIP 2
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
N,�•`, (OFFICE,BOARD,DEPARTMENT OR INSMUTION)
r T 1A- VDATE FROM TO SPEEDOMETER AUTO MILE E
� READING + NATURE OF BUSINESS MILES p �p c
POINT POINT START FINISH TRAVELED PER MILE
1 _ -
• m OY 071 Is I Lo 12
to 1Y1o,ner.. wG Prr
m ort G - M
-tfn \13 11614 11 Wic-
t
x 7- rA&nov\- 9y N
C�cA 4
• — •c' 13 H
1 Pn :G a
l3 o,n --ro.1.
zo 11 Lk 141,
2l0 _ 'M
ov s 11 ( O
2 . T�. •W L Lrn d
W d
ov% nn obb 1 r
AUTO LICENSE NO. TOTALS 3g� oZ I
+ 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 le a11y d ,after alioti ing justa 'ts
and that no part of the same 1has been paid.
Date `�• �� .1 ..
Juju - 2014
IACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service,where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
358411 Hammons, Jennifer Terms
634 Northview Ave Date Due
Indianapolis, IN 46220
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
5/30/14 Reimb. Mileage 5/1 -5/30/14 $ 216.16
Total Is 216.16
I hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
Clerk-Treasurer
i
Voucher No. Warrant No.
358411 Hammons,Jennifer allowed 20
634 Northview Ave
Indianapolis, IN 46220
In Sum of$
$ 216.16
I'
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE !.
i.
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
Board Members
Dept#
' p I
1081-10 Reimb. 4343000 $ 216.16 1 hereby certify that the attached invoice(s), or
bill(s)is(are)true and correct and that the
I or services itemized thereon for
which charge is made were ordered and
received except
I
I
19-Jun 2014
Signature
$ 216.16 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund