HomeMy WebLinkAbout188361 08/03/2010 CITY OF CARMEL, INDIANA VENDOR: 360925 Page 1 of 1
e ONE CIVIC SQUARE JENNIFER HOLDER
CARMEL, INDIANA 46032 5716 DURHAM CASTLE CT APT 137 CHECK AMOUNT: $11.10
INDPLS IN 46250 CHECK NUMBER: 188361
CHECK DATE: 813/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343000 11.10 TRAVEL FEES EXPENSE
"r
PRLSCMEO BY STATE BOARD Or ACCOUNTS GENERAL FORM NO. 101 Ll"
MILEAGE CLAIM VA I j
((}OVERNIAENTAL UNro
ON ACCOUNT OF APPROPRIATION NO. FOR
(OHICE, BOARP, DEPARn EXT OR INS17Rin10N)
SPEEDOMETER AUTO NILEE
/ATE FROM TO V REAPING NATURE OF BUSINESS MILES {a,
POINT POINT START FINISH TRAVELED
PER M_ ILE
I Li Ll 1 Z Z
0 C Q 2�
li 2.
NMr VIPW kr G
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 claimed is legally due, after allowing all just credits
and that no part of the same has been paid.
'Date
1 5 ZQIQ
BY..
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.
Holder, Jennifer Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
6/23110 Reimb Mileage 618 6/23/10 11.10
Total 11.10
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.
Holder, Jennifer Allowed 20
In Sum of
11.10
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1082 -1 Reimb 4343000 11.10 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
PkNV Yli'Ytbi'
Signature
11.10 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund