HomeMy WebLinkAbout195538 03/16/2011 CITY OF CARMEL, INDIANA VENDOR: 364002 Page 1 of 1
0 ONE CIVIC SQUARE ASHLEY LIVINGSTON
CARMEL, INDIANA 46032 3404 WOODFRONT PLACE CHECK AMOUNT: $85.68
INDIANAPOLIS IN 46222 CHECK NUMBER: 195538
CHECK DATE: 3/16/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 85.68 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM A.G. 101 0995)
n MILEAGE CLAIM r
t66VER TAL IIHI'FF
ON ACCOUNT OF APPROPRIATION NO- FOR
(OFFICE, BOARD, DEF"T1D7n OR INSrMnION)
SPEEDOMET AUTO
DATE FROM TO I READING VAGE
NG NATURE OF BUSINESS MILES Q t
Za POINT POINT START FINISH TRAVELED PER MILE
A0 c.,
4 f
AAO
2 -9 WC how
y 7
r 7
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. w
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 part of the same has been paid.
Date
A
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.
364002 Livingston, Ashley Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
3/3/11 Reimb Mileage 2/1 -3/3/11 85.69
Total 85.68
1 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.
364002 Livingston, Ashley Allowed 20
In Sum of
85.68
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #[TITLE AMOUNT Board Members
Dept
1081 -2 Reimb 4343000 85.68 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
85.68 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund