HomeMy WebLinkAbout188595 08/03/2010 CITY OF CARMEL, INDIANA VENDOR: 364278 Page 1 of 1
ONE CIVIC SQUARE PATRICK BURTCH CHECK AMOUNT: $23.95
CARMEL, INDIANA 46032 11854 ASHTON DR
y' op Go FISHERS IN 45038 CHECK NUMBER: 188595
CHECK DATE: 8/4/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343000 23.95 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD Of ACCOUNTS n GENERAL FORM NO. W') (1986)
MILEAGE CLAIM
To r{
it �'T 6�
GOVERNMENTAL UNI'n
ON ACCOUNT OF APPROPRIATION NO. FOR
tOV. I E, BOARD, DEPARTMENT OR 1NSITTUTION]
D TE
FROM TO SPEEDOMETER
READING AUTO MILEAGE
2a POINT POINT START FINISH NATURE OF BUSINESS TR
ED Z
PER MILE
L CLQ I o Y m L f
k ti 110
b J5 C kckb M Li- 14
to 6 n S
i n
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Z I
'LIE k c
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C
AUTO LICENSE NO. TOTALS J 1 J
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. Z3. e
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby cerlily that the foregoing account is just and correct, that the amount claimed is legal all just credits
and that no pal of the same has been paid,
Date 711 1 1 0
1- VIJ
JILL 5 2010
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.
364278 Burtch, Patrick Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
711110 Reimb Mileage 611!10 711110 23.95
Total 23.95
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
20_
Clerk- Treasurer
Voucher No. Warrant No.
364278 Burtch, Patrick Allowed 20
in Sum. of
23.95
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #FFITLE AMOUNT Board Members
Dept
1082 -1 Reimb 4343000 23.95 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
29 -Jul 2010
Signature
23.95 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund