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CITY OF CARMEL, INDIANA VENDOR: 360144 Page 1 of 1
�4 0 ONE CIVIC SQUARE CYNTHIA CANADA CHECK AMOUNT: $66.05
CARMEL, INDIANA 46032 11508 LUCKY DAN DRIVE
NOBLESVILLE IN 46060 CHECK NUMBER: 194121
CHECK DATE: 2!312011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 66.05 TRAVEL FEES EXPENSE
PMCRIRED 137 STATE BOARD OF ACCOUNTS GENRRAI- FORA 110_ ICI (19857
MILEAGE CLAIM
(GO9rRNMENTAL UNIT) 1
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF BOARD, DETARTI3](T OR INsr=1ON)
SPEEDOMETER
DATE FROM TO READING MILES c
NATURE OF BUSINESS
2b POINT POINT START FINISH TRAVELED P
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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. TOTA L ZFa5
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 all just credits
end that no p rt of the s m been paid.
�/f�D Date !jam
JAN 2011
r-7:
PRYSCRIBCD BY STATE BOARD OT ACCOUNTS GENERAL FORM NO. 101 (1985)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO- FOR
(OFFICE., BOARD, DU& AnWMrr OR 1NSn 10?1)
SPEF.0OMETER
DATE FROM TO V RFJiDtNG AUTO SS MILEAGE
ZQ POINT V POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MLLE
YL T r I 3,
i/Yw
3 V=
i
AUTO LICENSE NO. TOTALS
SPEEDOMETER READING columns are to be osed 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 all just credits
end that no att of he ame has been paid
Dale 4 1 -2.
l✓� JAN 2011 L
R
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.
360144 Canada, Cyndi Terms
11508 Lucky Dan Dr
Noblesville, IN 46060
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
12/30/10 Reimb. Mileage 11117 12130/10 66.05
Total 66.05
1 hereby certify that the attached invoice(s), or bili(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
2
Clerk- Treasurer
Voucher No. Warrant No.
360144 Canada, Cyndi Allowed 20
11508 Lucky Dan Dr
Noblesville, IN 46060
In Sum of
66.05
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -5 Reimb. 4343000 66.05 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
27 -Jan 2011
Signature
66.05 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund