HomeMy WebLinkAbout181976 02/03/2010 ,fr
�CITY OF CARMEL, INDIANA VENDOR: 362504 Page 1 of 1
t!
t e a ONE CIVIC SQUARE MICHAEL JACKSON
k,. %a CARMEL, INDIANA 46032 5914 SANDALWOOD DRIVE CHECK AMOUNT: $85.07
4 CARMEL IN 46033 CHECK NUMBER: 181976
CHECK DATE: 213/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4343000 85.07 TRAVEL FEES EXPENSE
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(G l R DEP t t 4ARRTMENTarr �R
(O FILE, B A T O INSTITUTION)
SPEEDOMETER AUTO MILEAGE DATE FROM TO READING AGE
MILES Q ILE Q
POINT POIN T "X,,1 START FINISH
NATURE OF BUSINESS TRAVELED
1 V PER MILE r. r iAc.(I
0 3 15( 4n c. w;x: Ir. Cr,. t J4 l L i A t r20 Go
IMMOIMIlill
i.OM
=M
EMEM
kiln_
AUTO LICENSE NO. TOTALS 6 a C Lio pc.) V
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
end that no part p1 the same has been paid.
Date i 1( t v2E�,�,c
am_ t /3 -o
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form.
That it is duly authenticated as required
by law
That it is based upon statutory authority.
That it is apparently correct
incorrect
Disbursing Officer
On Account of Appropriation No. for
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Allowed 19__ o
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in the sum of $m CD CD
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(Board or Commission)
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FILED
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(Official Title)
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A.E. BOYCE CO„ INC. MUNCIE, IN 01136
Carr 1 ;e1 o Cay
Parks &Recreat bn
Employee Expense Reimbursement Request
Date of
Receipt Vendor listed on receipt Fund Lao, Account Line Account Description Amount Purpose of Expense
1 r lao P r O S 0 ZJ m 1 13 2 I r n; /i I (0, -7 r
fj 1 a r LI3`( 3 r7r�) rra; nen t 3
r����Got��n �J U C04crcrtct Z. Llnt..
<6 l Z vi n C c:w �'S f�/t .'lG [0
/2uta 9.( 0 i ®a v t eta
All receipts should be attached in the same order as listed above.
TOTAL
Name (print) fin K c ,Tat, r S. rt ;7.3
Check Address 5 7( f9p _ic LI, JAN Y 4 1010
payable to:
City, St, Zip rp,r 171,/ '(CO3 3 Signature I2p L/J"7C� Date: J II L 2OIO
Tr? Approved by: 7 ,.,P Date: j 3 1 tY
Revised 3 -2 -07 by Business Services
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.
362504 Jackson, Michael Terms
5914 Sandalwood Drive
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1/13/10 reimb. Mileage INLA conference 40.00
1/13/10 reimb. INLA Conference expenses 45.07
Total 85.07
I 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
Voucher No. Warrant No.
362504 Jackson, Michael Allowed 20
5914 Sandalwood Drive
Carmel, IN 46033
In Sum of
85.07
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or Board Members
INVOICE NO. ACCT #/TITLE AMOUNT
Dept
1125 reimb. 4343000 40.00 I hereby certify that the attached invoice(s), or
1125 reimb. 4343000 45.07 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
28 -Jan 2010
ItLd Id'
Signature
85.07 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund