235764 08/13/14 1+pr G�q��
CITY OF CARMEL, INDIANA VENDOR: 358408
® I ONE CIVIC SQUARE TIFFANY BUCKINGHAM CHECK AMOUNT: $"" "151.20'
:�. ?a; CARMEL, INDIANA 46032 5057 E 71ST STREET CHECK NUMBER: 235764
9,;,.. INDIANAPOLIS IN 46205 CHECK DATE: 08/13/14
fTON G�•
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343000 REIMB 151.20 TRAVEL FEES & EXPENSE
RECEIVE
JUL,,3 0 2014
PRESCRIBED BY STATE BOARD OF ACCOUMS .� GENERAL FORM 116.IQl(1986)
MILEAGE CLAIM o
vr'` GI
(Gov ENIAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFi7CE,BOARD,DUARTMENT OR 1NsnTuTION)
FROM TO SPEEDOMETER AUTO 11ILEAGE
DATE READING + NATURE OF BUSINESS TRAVELED a . C
POINT POINT START FINISH PER MILE
-
�c
—T
Z-2- VVIUA0VI
Ll
_ ,'2 C
n
L2 All I Z>rAc
L
L
r ...s
`7 f?7
C(.hA
i
rr
9 � f
i'Ai �
o 0 0-ba✓YI 2-2—CC. I
_ C_ za n Q el t TSF
C
- 1 •tet t
AUTO LICENSE NO. TOTALS 1 1
+ 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 thatthe foregoing account is just and correct,that the amount claimed is legfily due,after allowing all just credits,
and that no part of the same has been paid.
Date
i
1
ACCOUNTS 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.
358408 Buckingham, Tiffany Terms
5057 E 71 st St
Indianapolis, IN 46205
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
7/18/14 Reimb. Mileage 5/8- 7/18/14 $ . 151.20
Total $ 151.20
1 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
, 20
Clerk-Treasurer
I
Voucher No. Warrant No.
358408 Buckingham,Tiffany Allowed 20
5057 E 71 st St
Indianapolis, IN 46205
In Sum of$
$ 151.20
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. A.CCT#/TITL AMOUNT Board Members
Dept#
1082-4 Reimb. 4343000 $ 151.20 I 1 hereby certify that the attached invoice(s), or
i
bill(s)is(are)true and correct and that the
i materials or services itemized thereon for
which charge is made were ordered and
received except
I�
I
7-Aug 2014
Signature
$ 151.20 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund