HomeMy WebLinkAbout252364 12/08/15 y u•_C4gb
�s`/ % CITY OF CARMEL, INDIANA VENDOR: 368794
ONE CIVIC SQUARE APRIL MURRAY CHECK AMOUNT: $********12.01*
s„ ;_� CARMEL, INDIANA 46032 Go LAW CHECK NUMBER: 252364
a,;TON�• CHECK DATE: 12/08/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1180 4343004 12.01 TRAVEL PER DIEMS
2scribed by State Board of Accounts
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General Form No.101(1955)
MILEAGE CLAIM
City of Carmel, Indiana TO -1 )`( 1 1 1 Y 10ry- DR.
(Governmental Unit)
De artment of Law - 1180 On Account of Appropriation No. 434-3004 for Mileage
(Office,Board,Department or Institution)
DATE FROM TO ODOMETER READING" NATURE OF BUSINESS AUTO MILES MILEAGE
20 Point Point Start Finish TRAVELED PER MILE
1 I I - LI L-1-o I, 2 O
t
Auto License No. TOTALS j /Z O 1
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
ursuant to the provisions Land penalties of Chapter 155;Acts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after
lowing all just credits, and that no part of the same has been paid.
ate
Clcdrn No. Warrant No. I have examined the within claim and
hereby certify as follows:
IN FAVOR OF
That it is in proper form;
Alac, OIC(COLI That it is duly authenticated as required
by law;
That it is based upon statutory authority;
That it is apparently correct
Z , D l incorrect
On Account of Appropriation No.4343004 for
DWDursing Officer
Department of Law - 1180
Allowed 20 (° o
in the sum of$ o
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Municipal Emergency Services
IN SUM OF $
75 Remittance Drive, Suite 3135
Chicago, IL 60675
i
$950.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
1120 692076 43-560.01 $950.00 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
DEC _ 7 2515 li
r�
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized'must show: kind of service,where performed, dates service rendered, by
iwhom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
692076 $950.00
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
120
Clerk-Treasurer