HomeMy WebLinkAbout333310 12/11/18 J! CITY OF CARMEL, INDIANA VENDOR: 371639
® ONE CIVIC SQUARE ALYSSA HOLSTEN CHECK AMOUNT: $********32.70*
��� CARMEL, INDIANA 46032 209 VAILI COURT CHECK NUMBER: 333310
9;�_��` INDIANAPOLIS IN 46280 CHECK DATE: 12/11/18
ETON�
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 32.70 TRAVEL FEES & EXPENSE
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
VOUCHER NO. WARRANT NO.
An invoice of bill to be properly itemized must show;kind of service,where performed,dates service rendered,by
Vendor# 371639 Allowed 20_ whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
Holsten, Alyssa Payee
209 Vali Court
Indianapolis, IN 46280 In Sum of$ Purchase Order#
371639 Holsten,Alyssa Terms
$ 32.70 209 Vali Court Date Due
Indianapolis,IN 46280
ON ACCOUNT OF APPROPRIATION FOR
108-ESE Fund
PO#ornvolce Description
Dept# INVOICE No. ACCT#fTITLE AMOUNT Invoice Date Number (or note attached invoice(s)or bill(s)) PO# Amount
1081-6 Reimb 4343000 $ 32.70 Board Members 12/3/18 Reimb Mileage 11/13-12/3/18 $ 32.70
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
$ 32.70 Total $ 32.70
December 3,2018
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
claim paid motor vehicle highway fund Signature 20_
Accounts Payable Coordinator Clerk-Treasurer
Title
ddYess . Z0� �al� CibU��� .
PRESCRIBED BY STATE BOARD OF ACCOVIIIS
Ge MDL FORM No.191(1986)
MILEAGE CLAIM
� TO v
—_ (GOV&INMENFAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD,DEPAR OR INSTiTiRION)
DATE FROM TO SPEEDO
A TEER AUTO
POINT POINT START FINISH NATURE OF BUSINESS MILES
TRAVELED PER MIM
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AUTO LICENSE NO. TOTALS `f
+ 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
and that no pa of the same has been paid. Is ally due,after allowing all just credits:
Data
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