HomeMy WebLinkAbout302357 08/25/16 G/ CITY OF CARMEL, INDIANA VENDOR: 369160
d I ONE CIVIC SQUARE MAX ELLIS CHECK AMOUNT: $********43.12*
4. ?� CARMEL, INDIANA 46032 C/O PARKS CHECK NUMBER: 302357
CHECK DATE: 08/25/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343000 072916 43.12 TRAVEL FEES & EXPENSE
Voucher No. Warrant No.
Allowed 20
369160 Ellis, Max
1821 Marion Drive
Indianapolis, IN 46240 In Sum of$
$ 43.12
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TITL AMOUNT Board Members
Dept#
1082-12 Reimb 4343000 $ 43.12 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
August 17, 2016
Signature
$ 43.12 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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.
Terms
369160 Ellis, Max
1821 Marion Drive
Indianapolis, IN 46240
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
7/29/16 Reimb Milege 5/4- 7/28/16 $ 43.12
Total $ 43.12
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
GENERAL FORM NO.101(ISM
PRESCRIBED By STATE BOARD OF ACCOUNTS
MILEAGE CLAIM
(GOVERNMENTAL U14111 ON ACCOUNT OF APPROPRIATION NO. FOR
(OMCE,BOARD,DEFAMIER OR MSYLTUVON)
SPEEDOMETER AUTO
DATE FROM TO READING + NATURE OF BUSINESS MILES @
POINT POINT START FINISH TRAVELED PER MILE
c C
r, TD ME ILA
5 Acl? 0
C1--r I�I'.� .
7 Wr
/J
-7
-7
7 'LS
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 1953,1 hereby certify that the foregoing account is just and correct,that the amount claimed is legally due,after allowing all just credits
and that no part of the same has been paid.
Date