HomeMy WebLinkAbout182313 02/17/2010 CITY OF CARMEL, INDIANA VENDOR: 359554 Page 1 of 1
i ONE CIVIC SQUARE CRYSTAL ETHRIDGE
CARMEL, INDIANA 46032 8821 GANTON COURT CHECK AMOUNT: $145.20
INDIANAPOLIS IN 46234 CHECK NUMBER: 182313
CHECK DATE: 2!1712010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 145.20 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NG. 161 {1985)
MILEAGE CLAIM
(GOVERNMENIAL UN n}
ON ACCOUNT OF APPROPRIATION NO_ FOR
(OF;ICE, BOARD. DFPARTMExT OR INS'TMJTION)
FROM TO T SPEEDOMETER AUTO E
DATE READING
2a POINT POINT START FINISH N TRAVELED
MILES D
PER MILE
fflonniQ n
Ajoy 3 w G a `L'
W C 'Z3
we oium
O 77 e
6
a
t Y czn v(7
20
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M Lit
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AUTO LICENSE NO- TOTALS
SPEEIDQMETER READING columns are to be used oniy 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 aliowing all just credits
end that no part of the same has been paid.
Dale
r
i JAN
h
ACCOUNTS PAYABLE VOUCHER
i 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.
359554 Ethridge, Crystal Terms
8821 Ganton Ct
Indianapolis, IN 46234
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1125110 Reimb, Mileage 11/2 12/18/09 145.20
Total 145.20
I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with 1C 5- 11- 10 -1.6
,20
Clerk- Treasurer
Voucher No, Warrant No.
359554 Ethridge, Crystal Allowed 20
8821 Ganton Ct
Indianapolis, IN 46234
z In Sum of
145.20
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -10 Reimb. 4343000 145.20 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
11 -Feb 2010
Signature
145.20 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund