HomeMy WebLinkAbout164617 10/16/2008 CITY OF CARMEL, INDIANA VENDOR: 361544 Page 1 of 1
ONE CIVIC SQUARE KEISHA BORUFF CHECK AMOUNT: $25.14
CARMEL, INDIANA 46032 5409 HOLLY SPRINGS DR w
INDPLS IN 46254 CHECK NUMBER: 164617
CHECK DATE: 10/16/2008
DEPARTME ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343000 25.14 TRAVEL FEES EXPENSE
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PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORM NO. 101 (1988)
MILEAGE CLAIM
TO 1, I Sh GI �Yu
(GOVERNMENTAL UNIT)
t d Is CI I Lk7 M ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT O �INNSTI 'UTION) b a b ud
FROM TO SPEEIIOMETER
DATE READING AUTO MILEAGE
19 POINT POINT START FINISH NATURE OF BUSINESS MILES c�� 5
TRAVELED PER MILE
2� f 0, o �i 2 2 3 5 ici LO i
s 2tln 011 Me W oog Manan -P(--r d ek u O
(vl 41 C o lgLi 2 38 2 1
W o d s 5Rq(0 U g
u 11 2 ,0 ec \i"IZ upon c o"Ai 21ua 3y 21 H t
�Q r e ttE j t a o�
REP
0 2008
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 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
znd that no�]p,a�rt of the same has been paid. J
:Date
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.
Terms
361544 Boruff, Keisha
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
25.14
8112108 reimbursement Mileage 814108 8/11108
Total 25.14
bill(s) is (are) true and correct and I have audited same in accordance
I hereby certify that the attached invoice(s), or
with IC 5- 11- 10 -1.6
20_,
Clerk- Treasurer
Voucher No. Warrant No.
361544 Boruff, Keisha Allowed 20
In Sum of
25.14
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
f PO# or INVOICE NO. ACCT #!TITLE AMOUNT Board Members
Dept
1046 reimbursement 4343000 25.14 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
1 -Oct 2008
Signature
25.14 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund