320175 01/04/18 CITY OF CARMEL, INDIANA VENDOR: 358408
d c' ONE CIVIC SQUARE TIFFANY BUCKINGHAM CHECK AMOUNT: $*******120.91
?Q CARMEL, INDIANA 46032 5057 E 71ST STREET CHECK NUMBER: 320175
INDIANAPOLIS IN 46205 CHECK DATE: 01/04/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER, AMOUNT DESCRIPTION
1081 4343000 REIMB 120.91 TRAVEL FEES & EXPENSE
. 1 1
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
VOUCHER NO. WARRANT NO.
An invoice of bill to be properly itemized must show;kind of service,where performed,dates service rendered,by
Vendor# 358408 Allowed 20_ whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
Buckingham,Tiffany Payee
5057 E 71 st Street
Indianapolis, IN 46205 In Sum of$ 358408 Purchase Order#
Buckingham,Tiffany Terms
$ 120.91 5057 E 71 st Street Date Due
Indianapolis, IN 46205
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO#ornvoice nvolce Description
Dept# INVOICE NO. ACCT#!TITLE AMOUNT Date Number (or note attached invoice(s)or bill(s)) PO# Amount
1081-2 Reimb 4343000 $ 120.91 Board Members 12/4/17 Reimb Mileage 9/27-12/4/17 $ 120.91
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
$ 120.91 Total $ 120.91
December 27,2017
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
Cost distribution ledger classification if IPAMVXA�—
claim paid motor vehicle highway fund Signature 20_
Accounts Payable Coordinator Clerk-Treasurer
Title
GENERAL FORM 110.101 119867
PRESCRIBED BY STATr BOARD OF ACCOUNTS
MILEAGE CLAIM
TO—
ON
o ON ACCOUNT OF APPROPRIATION NO. FOR
tOHICE,BOARD,DEFARTMD(r OR INsrmynox)
SPEEDOMETER AUTO 71ILEAGE
DATE FROM TO READING + NATURE OF BUSINESS MILS (953•S C
POINT POINT START FINISH TRAVELED PER MILE
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AUTO LICENSE NO. TOTALS 1�
+ 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,
rnd that no part of the same has been paid. �M� C
Date— ��—�
C
ES
DEC 2 1 1011
BBY: