HomeMy WebLinkAbout197880 05/27/2011 CITY OF CARMEL, INDIANA VENDOR: 365320 Page 1 of 1
4� ONE CIVIC SQUARE JACK MOLITOR CHECK AMOUNT: $63.75
CARMEL, INDIANA 46032 C/O ESE
CHECK NUMBER: 197880
CHECK DATE: 5/27/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 63.75 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD Or ACCOUNTS GYME31AL FORW NO. 101 (1484)
MILEAGE CLAIM 7 r I W1
C VV
I j
S (GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE HOARD, DEPARTWZ TT 08 INSnTUTION)
SPEEDOMETER
D FROM TO READING AUTO AGE
NATURE OF BUSINESS MILES (y
POINT TRAVELE
POINT START FINISH D PER 3.SILE
ZZ I
4�i 11 \4�
I
AUTO LICENSE NO- TOTALS 5
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. r
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 lega ue, ter akiowin5 justcredits--,--
end that no part of the sarq as been paid.
Date LL� f
t
1 2011 pld
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.
Molitor, Jack Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
4129111 Reimb Mileage 3121 4/29/11 63.75
Total 63.75
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.
Molitor, Jack Allowed 20
In Sum of
63.75
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE N0. ACCT #fTITLE AMOUNT Board Members
Dept
1081 -9 Reimb 4343000 63.75 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
19-May 2011
Signature
63.75 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund