HomeMy WebLinkAbout188437 08/03/2010 CITY OF CARMEL, INDIANA VENDOR: 362749 Page 1 of 1
ONE CIVIC SQUARE KELSEY MILLER
CHECK AMOUNT: $76.75
CARMEL, INDIANA 46032 13259 EASTWOOD LN
io'2u FISHERS IN 46038 CHECK NUMBER: 188437
CHECK DATE: 8/312014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343000 76.75 TRAVEL FEES EXPENSE
PRESCRIBED By STATE BOARD OF ACCOUNTS GENERAL FORM NG. 10I 119867
MILEAGE CLAIM
C P ENTAL UN]ri
s ON ACCOUNT OF APPROPRIATIO O. FOR
i TO
(p R AR DE7ART?4tlfr OR iNSrrnTTION)
SPEEDOMETER AUTO I,I"AGE
DATE FROM TO BEADING NATURE OF BUSINESS MILES C� i
Zb POWT POINT START FINISH TRAVELED
PER MILE
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AUTO LICENSE NO. OTALS l r vvv
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map: f�Y'� 1 WWW t
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 al wing all lust redits
End that no a of the sa me been paid. S..� ZZ
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JUL 2010 Ci
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PRESCRIBED BY STATE BOARD OF ACCOUNTS
1 GEXFRAL FORM NO. 101 (19057
n MILEAGE CLAIM
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(GOVERNMENTAL UNIT} ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, HOARD, DEEAAT1 OR INSTnWJON]
SPEEDOMETER
FROM TO AUTO MILEAGE
DATE READING
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED r
PER MILE
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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 1 ally due, after allowing all just credits
end that no ant f th sane has been aid t
Date L't,
JUL 5 2010
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.
362749 Miller, Kelsey Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
6122/10 Reimb. Mileage 4114 7/6/10 76.75
Total 76.75
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.
362749 Miller, Kelsey Allowed 20
In Sum of
76.75
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1082 -2 Reimb. 4343000 76.75 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
76.75 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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