HomeMy WebLinkAbout186624 06/17/2010 CITY OF CARMEL, INDIANA VENDOR: 065950 Page 1 of 1
ONE CIVIC SQUARE DIANA CORDRAY
20 CARMEL, INDIANA 46032 11843 STONEY BAY CIRCLE CHECK AMOUNT: $55.39
CARMEL IN 46033 -9501 CHECK NUMBER: 186624
CHECK DATE: 6/17/2010
DEPARTMENT ACCOUNT PO NUM INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 47.89 OTHER EXPENSES
1701 4343004 7.50 TRAVEL PER DIEMS
Prescribed by State Board of Accounts General Form No. 101 (1955)
MILEAGE CLAIM
TO DR.
(Governmental Unit)
On Account of Appropriation No. for
(Office, Board, Department or Institution)
DATE FROM TO 9
ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE
0 Point Point Start Finish TRAVELED PER MILE
b
1 s
Auto License No. TOTALS
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, 1 hereby certify that the foregoing account is just and correct, that the amount claime legally due, after
allowing ali just cr s, and that no part of the same has been paid.
Date
Claim No, Warrant No. l have examined the within claim and
hereby certify as follows:
IN F�VOR OF
That it is in proper form;
d
That it is duly authenticated as required
by law;
That it is based upon statutory authority;
I
That it is apparently correct incorrect
On ccount of Appropriation No, 2�__
OD Disbursing Officer
Allowed 20 (D
in the sum of
m
m
D
(D(
(D
o (D
(Bocad or Commission)
(D
FILED
5
n m
0
m
Q
(D (D
Q(D
m
Ln
(Official Title) D
O
O
Prescribed by Slate Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or 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.
Terms
Date Due
Invoice Invoice i Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
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.
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
6 t^- V ,I acl I M� APW
n �)c tl Board Members
PO# or INVOICE NO. ACCT AMOUNT
DEPT. 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
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund