HomeMy WebLinkAbout195467 03/16/2011 CITY OF CARMEL, INDIANA VENDOR: 360926 Page 1 of 1
ONE CIVIC SQUARE SHAVONNE HOLTON CHECK AMOUNT: $78.03
s CARMEL, INDIANA 46032 3707 N MERIDIAN ST APT 3B
INDIANAPOLIS IN 46208 CHECK NUMBER: 195467
CHECK DATE: 3/16/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 78.03 TRAVEL FEES EXPENSE
PRCSCRIB ED HY STATE BOARD OF ACCOUNTS N
1 CINERAL FORM O. 101 (1496)
?C' Q e C MILEAGE CLA hn 1
S t l
I (aaVERNMENIAL UNITI
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF21cz, BOARD, DEPARTM U(r OR INSTTTUAON)
't M I
SPEEDOMETER AUTO �EA�GE
FROM TO READING NATURE OF BUSINESS MILES
2 DA'�E
(l POINT POINT START FINISH TRAVELED 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 1S5, Acts 1953, I hereby certify that the foregoing account is jusl and correct, that the amount claimed i s l egally due Iter allowing ail just credits r
end that no, part of the same has been paid.
Date G
P P �44 i` i FEB 2 R 2011
PRLSCRIBED BY STATE BOARD OF ACCOUNTS
AL FORM NC. 101 119861
MILEAGE CLAIM \/dY') yke k�n
,r�s E -)c __:s
E 1 VERNMENTAL nNITI
1 ON ACCOUNT OF APFROPALATION N0- FOR
(OFiTCE, BOARD. DrlARTW](r OR tNST rVT1ON)
SPEEDOMETER
HATE FROM TO READING AUTO a V tGE
t NATURE OF BUSINESS M11M
POINT POINT START FINISH T7tAVELED PER MILE
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m
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AUTO LICENSE NO- TOTALS L5 3 J
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 e 1 y d e, aft a o ulg all just credits
end that no art of the same has been paid.
Date Ve a 1
l
�8 2011
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.
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
2123111 Reimb. Mileage 113 2/21111 78.03
Total 78.03
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$
78.03
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -1 Reimb. 4343000 78.03 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
10 -Mar 2011
Signature
78.03 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund