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189749 09/14/2010 CITY OF CARMEL, INDIANA VENDOR: 360417 Page 1 of 1 F ONE CIVIC SQUARE JESSICA DAVIS CHECK AMOUNT: $129.78 CARMEL, INDIANA 46032 CHECK NUMBER: 189749 CHECK DATE: 911 412 01 0 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4343000 129.78 'TRAVEL FEES EXPENSE 'P�p�-i l 1 l0 PRESCRIBED BY STATE BOARD OF ACCOUNTS t GENRRAL FORM NQ. 10) (MO MILEAGE CLAIM 1 4 (f� V To JJJ 1 t,1 V 1 1GOVERNMENIAL UNIT} ON ACCOUNT OF APPROPRIATION NO- FOR (OF.IU, BOARD, DEPARTMENT OR 1N5TRUrJQN) SPEEDOMETER DATE FROM TO READING AUTO MILEAGE LES �a POINT POINT STAA7 FINISH NATURE OF BUSINESS TRAVELED PER MILE yllnrw AUTO LICENSE NO. TOTALS D 5PEEDOMETER 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 1853, I hereby certify that the foregoing account is just and correct, that the amount claimed is le (A due, aft r al', in all ju ed s r ,end that a pas f the same has been paid. •Date �I lU I D C� 3BW AUG 2 U 2010 18Yo SL)Mnl�v_ l PRESCRIBED BY STATE 50ARD OF ACCOUNTS GENERAL FORM 140. 101 (3986) MILEAGE CLAIM l ��n I (GOVERNMENTAL UNIT) O ON ACCOUNT OF APPROPRIATION ON NO. FOR {OFFICE, HOARD, DEFARng7Fr on 1NSTRUr10N) FROM Tp SPEEDOMETER AUTO I+ULEAGE DATE READING Zb NATURE OF BUSINESS WLES POINT POINT START FINISH TRAVELED PER MILE I 1UT Jut 1( i i 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 legal due, after a io q j e S.- U end that no a of th7sam,� has been paid. -Date l !2 I �U9W a I AUG M 2010 r W m,` PRPSCAIBED B7 SrASE HOARD OF ACCOUNTS GENFBAL FORM NO. 104 0M) MILEAGE CLAIM TO (GOVERNMENrAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR (OF, BOARD, DEPAATUnIT OR 1NSTRSrr1ON) SPEEDOMETER FROM TO AUTO IdILEAGE DATE READING f 2d NATURE OF BUSINESS MILES Q, C TRAVELED POINT POINT START FINISH PER MILE c I I L L:A It Al 1 AUTO LICENSE NO. TOTALS 1 Z .0 2 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, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing ust credits j l end that no paji I tEtg s I e has been pnid, -Date D WrMT09193 a AUG 2..0 2010 Mal D GENERAL FORM NO. IC) 09BO ParsCRIEED BY STATE BOARD OF ACCOUNTS MILEAGE CLAIM r To tGOVERNAENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR (OFi iCY, POA RD, DFPARTIO]? oP IH52INIION) SPEEDOMETER AUTO )AMEAGE DATE FROM TO V READING MILES c 2- POINT POINT START FINISH NATURE OF BUSINESS 1'AA\IEL£O PER WLE bf 2Q- 4 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, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after aliowing a st credits and that no part �pf Jhe saln�ar been paid. Daie YF l L I l JJJ T (To AUG Z 2010 Bye Avg us+ �o PRESCRIBED BY STATE BOARD Of ACCOUNTS MILEAGE CLAIM GEMAL FOR11110. 101 V9BB1 To (,9 �c J [GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO- FOR 1 (O ➢rICE, BOARP, PFp AI[T18]!r OR 1NSTCTUIIONJ SPEEDOMETER AUTO MILEAGE DATE FROM TO READING t MILES c. Zb POINT POINT START FINISH NA TURE OF BUSINESS TRAVELED PER MILE I AUTO LICENSE NO. TOTALS s� SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. 2 -D, 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 alt just credits and that no part If the same ,.©has be�enn paid, Date ,1 em 3�-7 r% SEA p 7 2010 BYs....................... 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. 360417 Davis, Jessica Terms Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 8/19110 Reimb. Mileage 4!1 7114110 102.22 911/10 Reimb. Mileage 8110 8131110 27.56 Total 129.78 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. 360417 Davis, Jessica Allowed 20 In Sum of 129.78 ON ACCOUNT OF APPROPRIATION FOR 108 ESE PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1081 -11 Reimb. 4343000 102.22 1 hereby certify that the attached invoice(s), or 1081 -11 Reimb. 4343000 27.56 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 9 -Sep 2010 Signature 129.78 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund