241462 1 /27/2015 CITY OF CARMEL, INDIANA VENDOR: 358408
ONE CIVIC SQUARE TIFFANY BUCKINGHAM CHECK AMOUNT: 5"""`128.24`
s =q CARMEL, INDIANA 46032 5057 E 71 ST STREET CHECK NUMBER: 241462
INDIANAPOLIS IN 46205 CHECK DATE: 01/27/15
k 70N�
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 128.24 TRAVEL FEES & EXPENSE
I
Fi
6 2015
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO.10)11986)
MILEAGE CLAIM
TO
( VEIINMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD,DEEARTMIRfi 38 INSTITUTION)
DATE FROM To
SPEEDOMETER AUTO MILEAGE
READING + NATURE OF BUSINESS MILES :5-7 ko
2)LLLPOINT POINT START FINISH TRAVELED PERMILE
--ll Z 't C:7r 711A CC ILI
--
CL-le C-
G ca-
7
t
Il
C-
a �
--�--
Mar
C, 4
v _ Al
I a, c
i L ILI
C c-T
I
Z TGC.
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.
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 noartof the same has been paid.
Date �l�y 11 n
i
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 71st St
Indianapolis, IN 46205
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO* Amount
1/14/15 Reimb. Mileage 11/11/14- 1/14/15 $ 128.24
Total $ 128.24
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 ;
20_
Clerk-Treasurer
J
Voucher No. Warrant No.
j;
358408 Buckingham,Tiffany Allowed 20
5057 E 71 st St
Indianapolis, IN 46205
In Sum of$
$ 128.24
r
ON ACCOUNT OF APPROPRIATION FOR
i
108 -ESE
I
PO#or Board Members
Dept#
INVOICE N0. 4CCT#1TITLE AMOUNT
1081-2 Reimb. 4343000 $ 128.24 �, 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
I .
received except
January 22, 2015
Signature
$ 128.24 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund