HomeMy WebLinkAbout304913 11/09/16 qty tf. CITY OF CARMEL, INDIANA VENDOR: 358408
® �i ONE CIVIC SQUARE TIFFANY BUCKINGHAM CHECK AMOUNT: $*******167.67*
;. ;_� CARMEL, INDIANA 46032 5057 E 71 ST STREET CHECK NUMBER: 304913
9,F� INDIANAPOLIS IN 46205 CHECK DATE: 11/09/16
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 110716 167.67 TRAVEL FEES & EXPENSE
Voucher No. Warrant No.
358408 Buckingham, Tiffany Allowed 20
5057 E 71 st St
Indianapolis, IN 46205
In Sum of$
$ 167.67
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. CCT XTITL AMOUNT Board Members
Dept# Board Members
1081-2 Reimb. 4343000 $ 167.67 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
November 4, 2016
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Signature
$ 167.67 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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OCT 7 2916
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GENRRAL FORM 110.101(1906)
PRESCRIBED BY STATE BOARD OF ACCOUNTS •^
MILEAGE CLAIM -IV�+•i 'a�lGi'�+11Gi �n
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(GOVERNMENruGuN1T1 ON ACCOUNT OF APPROPRIATION NO. FOR
COM,CE,BOARD,DEPARTWENr OR INSTMMON)
SPEEDOMETER AUTO MILEAGE
FROM TO
2 DATE READING + NATURE OF BUSINESS TRAVELED
MILES @ —
861VnI POINT POINT START FINISH PER 14LE
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AUTO LICENSE NO- TOTALS
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+ 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 aliowing all just credits;
end that no part-of,thesame h_as been paid.
Date � a' �lJ
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