HomeMy WebLinkAbout238582 10/28/14 �! CITY OF CARMEL, INDIANA VENDOR: 360144
.i; ® , ONE CIVIC SQUARE CYNTHIA CANADA
CHECK AMOUNT: $*"**'*""93.80*
s, ;_� CARMEL, INDIANA 46032 11508 LUCKY DAN DRIVE CHECK NUMBER: 238582
9.y`,��oN��. NOBLESVILLE IN 46060 CHECK DATE: 10/28/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB. 93.80 TRAVEL FEES & EXPENSE
GENERAL FORM NO 3011 L9561
PRESCRIBED BY STATE BOARD OF ACCOUNTS
MILEAGE CLAIM
TO
4GOVERNMENTAL,vom ON ACCOUNT OF APPROPRIATION NO. FOR
(OFnCE.BOARD.DEPAXTUM OA INSTUMION)
SPEEDOMETER 7 AUTO
M= pGE
DATE FROM To I READING t
NATURE OF BUSINESS un rc
2-0POINT POINT START FINISH TRAVELED PER MILE
C-
yn M717 I L4--
s
9 - vY�mac_ —
OL
Ir
}
C
- e-
'-, ,
mc—
AUTO LICENSE NO. TOTALS t3
+ SPEEDOMETER READING columns ere 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 lust credits
end that no part;f the same has been paid.
qV
J0q .""Tw � ��
OCT 13 2014
BY:
PA►SCB BED BY STATL BOATD OF ACCOVt= GMEDAL FOAM 110 101 119M
MILEAGE CLAIM
TO
IGOVLUMENTAL.Wnl ON ACCOUNT OF APPROPRIATION NO. FOR
tOFi10E.HOARD.DWART&MRT OA VISTUM108)
DAn FROM TO I SPEEDOMETER AUTO b[It SAGE
I READING NATURE OF BUSINESS LE
POINT POINT STARFINISH TRA DD
3 GL
--
L MC-C —
sit
C --- c4 - I
IkIr
E
C C_ 31
YYIT S , '31 11
- _
19 1;;k, �.
a cc_ -► _ F q 11
t
°
3
C.C� c kS16
'
IT C_ '
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. QI 3 n 90 �0{c'
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 aliotiving all Ius cre 1
end that np part of the,same has been paid.
Date
I OCT 13 2014
BY:
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.
360144 Canada, Cyndi Terms
11508 Lucky Dan Dr
Noblesville, IN 46060
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
10/7/14 Reimb Mileage 7/31 - 10/7/14 $ 93.80
Total $ 93.80
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
Voucher No. Warrant No.
360144 Canada, Cyndi Allowed 20
11508 Lucky Dan Dr
Noblesville, IN 46060
In Sum of$
$ 93.80
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-5 Reimb 4343000 $ 93.80 1 hereby certify that the attached invoice(s), or
bill(s) is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
23-Oct 2014
Signature
$ 93.80 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I