HomeMy WebLinkAbout196471 04/13/2011 CITY OF CARMEL, INDIANA VENDOR: 361086 Page 1 of 1
ONE CIVIC SQUARE JACOB C MOORE CHECK AMOUNT: $39.78
CARMEL, INDIANA 46032 348ATHERTON DR
oN CARMEL IN 46032 CHECK NUMBER: 196471
CHECK DATE: 4/13/2011
DEPARTMENT ACCOUNT P O NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 39.78 TRAVEL FEES EXPENSE
PRESCRIBED HT STATE BOARD Or ACCOUNTS
r)r Eflu FOR1r NQ. 10:11900
MILEAGE CLAIM
To Ld✓ I
1 Q Qom
OVERNMENTAL UNn} ON ACCOUNT OF APPROPRIATION NO. FOR A 06 rl�-
(OMCr, HOARD. DEFART6MfT OR IN5TnW1O q
FROM TO .y. SPEEDOMETER M AUTO E
DATE READING
POINT POINT START FINISH NATURE OF BUSINEBf MILES 4
TRAVELED PER MILE
i
C. G(S rvr
G-(
/VVU 7
CIX Ldi 1
r^R a v 'r i S t /5 rne.4S
1 tl
AUTO LICENSE NO. TOTALS 7 V 7 8
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after aliowing all just credits r
and that no part of the same has been paid.
Date
r yj
1MA R 2 2 1011
BY........................
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
361086 Moore, Jacob Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
3118111 Reimb. Mileage 2116 3118111 39.78
Total 39.78
hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20,
Clerk- Treasurer
Voucher No. Warrant No.
361086 Moore, Jacob Allowed 20
In Sum of
39.7$
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #fTITLE AMOUNT Board Members
Dept
1081 -1 Reimb. 4343000 39.78 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
7 -Apr 2011
Signature
39.78 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund