HomeMy WebLinkAbout194219 02/03/2011 CITY OF CARMEL, INDIANA VENDOR: 360926 Page 1 of 1
ONE CIVIC SQUARE SHAVONNE HOLTON CHECK AMOUNT: $55.50
�.,,r...; CARMEL, INDIANA 46032 3707 N MERIDIAN ST APT 36
dory INDIANAPOLIS IN 46208 CHECK NUMBER: 194219
CHECK DATE: 2/3/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE N AMOUNT DESCRIPTION
1081 4343000 55.50 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NG. 101 {1966)
MILEAGE CL o h v n n e I L
(GOVERNMENTAL nNM Y IC f
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF71CP, BOARD, DEPARTWXKT OR INSTrWr1ON)
SPEEDOMETER
Z DATE FROM TO READING NATURE OF BUSINESS MILES E c
POINT POINT START FINISH TRAVELED PER MILE
c
i s0
c
r LAJO
IV
lzc AU
2 r
5
S
AUTO LICENSE NO_
TOTALS y 1
SPEEDOMETER READING columns are to be used only when distance between points cannot he 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 11 ue, a alio Ving all just Credits
and that no part oft same has been paid. nn
Date V o
I tv. JAIL
p
it
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.
360926 Holton, Shavonne Terms
8001 Canary Ln Apt A Date Due
Indianapolis, IN 46260
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1117/11 Reimb, Mileage 11/29 12/30/10 55.50
Total 55.50
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
i
Voucher No. Warrant No"
360926 Holton, Shavonne Allowed 20
8001 Canary Ln Apt A
Indianapolis, IN 46260
In Sum of
55.50
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -1 Reimb. 4343000 55.50 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
Is 55.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I