HomeMy WebLinkAbout319761 12/15/17 CITY OF CARMEL, INDIANA VENDOR: 369557
ONE CIVIC SQUARE AIMEE RICH CHECK AMOUNT: $**.....139.74*
CARMEL, INDIANA 46032 4907 SUNVIEW CIRCLE#1222 CHECK NUMBER: 319761
INDIANAPOLIS IN 46237 CHECK DATE: 12/15/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 139.74 TRAVEL FEES & EXPENSE
Voucher No. Warrant No.
Allowed 20
369557 Rich, Aimee
211 Junction Pass#2G
Westfield, IN 46074 In Sum of$
$ 139.74
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
Board Members
PO#or INVOICE NO. fkCCT#/TITLE AMOUNT
Dept#
1081-99 Reimb 4343000 $ 139.74 I 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
December 8, 2017
P*
Signature
$ 139.74 Accounts Payable Coordinator
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund
d
FDEC 0 5 2017
BY:..............................
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO.101(1905)
MILEAGE CLAQIMI-rrav�� 2�r •D IM JCb(-0Jq y 2j��j QQ l.4
�C k xideel Ctc-A �n110n m n f- tQ
C` urQ
AL Wan ON ACCOUNT OF APPROPRIATION NO: For—
(OFFICE,
O r(OFFICE,BOARD,DEPAATMFN7 OA 1NSnTUTION(
DATE FROM TO SPEEDOMETER
READING i_ AUTO MILEAGE
20 POINT POINT START NATUISHRE OF BUSINESS MIL L � SYgm
PER MILE
vs 1 3 01
S ' "7 L&
ID I w Vi k $
l L 5� 2 6*3
to• Co
p :
r
$jis.A'
i S " O 160t(5 P 1 1. a 41 Co
t T i 1 (o•1
RU-
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to 11 "ft- 'fM - ; 4.
l '1fo
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i t0.
` �*- q,
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 1853,I hereby certify that the foregoing account is just and correct,that the amount claimed is legally due,after allowing alljust or
and a} part of'tlie=sarae'lias been paid.
Dat
2,-
11:11111
!� Willrit.t"`iUUIa1i�dfi',iSS
DEC 0 5 2017
BY:..............................
PRESCRIBED By SLATE BOARD OF ACCOUNTS
GENERAL FOAM NO.101(1986)
MILEAGE CLAIM!
hided Sc hc�l �nrtUn rn +- TO_ TrOly e,� 1�2r i e.m tc ,t-0l�-y 3N3 0014
(GOVEAMLKIAL UNIT) 1
'r
C.Lp ON ACCOUNT OF APPROPRIATION NO.
(OHICE,BOARD,DEPARTMENT OR 1NSnrinlON) V ..;'r/1 I)"s!9 a, ,.✓w ', L
DATE FROM TO SPEEDOMET,'ER t�---�--=-�-�
READING AUTO MILEAGE
POINT POINTSTART FINISH NATURE OF BUSINESS MILES CW .g35 a
TRAVELED PER MILE
1 -6Nli
,s . 1.7-.,%3
. 2
lt�
i nc
to a L.
l� kic to
1
b Z
ito
10 ityr k -
io 1Z Ulf T _
t t l
O tl r 1C
a �I
tr .6 Lt 0 1
a r r"I2 D3
— c
.3
b iL -N 2
yr 2Ca
AUTO LICENSE NO, TOTALS 1
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined bir fixed mileage or official highway.map.
Pursuant to the proyisio v i, d 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
11"m
a�r^`r :and that no gait of the same Jrhas been paid.
Date
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