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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 t• 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 o tT w m p. O 0 n m Allowed 19__ o o a in the sum of $m CD CD M y N o H H (Board or Commission) gi sv o FILED 'C CD N R. a w Ei to co w (Official Title) "t o tD o 0 m 'd a o P. 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