HomeMy WebLinkAbout193465 01/05/2011 CITY OF CARMEL, INDIANA VENDOR: 356917 Page 1 of 1
ONE CIVIC SQUARE MELANIE LENTZ CHECK AMOUNT: $142.00
CARMEL, INDIANA 46032 4683 GRAND HAVEN LN APT F
INDPLS IN 46280 CHECK NUMBER: 193465
CHECK DATE: 1/5/2011
D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1160 R4343004 5418 142.00 MILEAGE REIMBURSEMENT
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FOAM NO. 101 (1986)
MILEAGE CLAIM
TO
R.Iaae- Levi� �uE C-, YtzKr \�yU LA AYA FF�:"A f gKi
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MIE
4 MLa f kfice t
IS 4 rvl>
0 l t b
t
(A Pun ceyl�fr i S b 2 i
1 'NCI S .C,I 6 6 iC, L C t +b
c, y x'117
LA
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r U ri A ct V\9' S VV�+
AUTO LICENSE NO. TOTALS 1 V =S 5 5
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 leg ue, after aliowin all just credits
and that no p rt of the same has been paid.
Date d
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form.
That it is duly authenticated as required
by law
That it is based upon statutory authority
That it is apparently
correct
incorrect
Disbursing Officer
On Account of Appropriation No. for
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A.E. BOYCE CO., INC. MUNCIE, IN 01136 to C) x
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORM NO. 101. (1486)
MILEAGE CLAIM,,,
TO 1 V t P�Ctnj�. Ur 1�-r 4 �3 Ca MW yW� IM., AYA i Y&Ig.
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING
MILES
19 POINT POINT START FINISH NATURE OF BUSINESS TRAVELED s
PER MILE
Ctl a All 1 C p -C
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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. r
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 legall due, after allowing all just credits
and that no part of th same has been paid.
Date /t
Claim No. Warnt No Ihv examined the wttnclaim and hereby
I FAVOR OF certify allobw:
That it is in proper form.
That baduly authenticated as mama
by law.
That it is b mau on2gUory au ±omy.
That a is apparently core
incorrect
Disbursing Omce
On Account d Appropriation No !o
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BOYCE CO., INC. _ca, ;a k 0
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM ��p
TO -Q, din Q �C.i�. VZ u lK� Cerra v Y�c t t� VI mot' 1 ,n r'j� {)�S, .J_ 1 V `'f l &D
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING U
MILES
19 POINT POINT START FINISH NATURE OF BUSINESS TRAVELED Q
PER MILE
l
C50 8 'V� Z. V C7
'I
1 eN Ca r n,,g
!iLe S
G 5
a'� if c� +nS fl
`Q
QA
1 r,
FOCAa O rd
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4 5
AUTO LICENSE NO. TOTALS Lx 4 I A a Lo
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 lega4 due, after allowing all jus credits
and that no part he same has been paid.
Date of U
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form.
That it is duly authenticated as required
by law
That it is based upon statutory authority.
That it is apparently correct
incorrect
Disbursing Officer
On Account of Appropriation No. for
o tT a
o a
0 N m
a
Ca
p 0 `e
Allowed 19 o a n a
n a a
ID
p m
in the sum of
'Y N
M w
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M G
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Q
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h Q+
R. n
0 o
(Board or Commission)
JL
c a
FILED
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w
(Official Title) o O
to 5*
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P. m
P tr, N.
A. E. BOYCE CO., INC. MUNCIE, IN 01135 IQ a
VOUCHER NO. WARRANT NO.
ALLOWED 20
Melanie Lentz
IN SUM OF
One Civic Square
Carmel, IN 46032
$142.00
ON ACCOUNT OF APPROPRIATION FOR
Mayor's Office
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
440(r Mileage Claim 43- 430.04 $142.00 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
n.
Monday, January 03, 2011
Mayor
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State 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 Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/22/10 Mileage Claim $142.00
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