HomeMy WebLinkAbout158704 04/15/2008 CITY OF CARMEL, INDIANA VENDOR: 360770 Page 1 of 1
ONE CIVIC SQUARE ADAM WOOD
CHECK AMOUNT: $135.95
CARMEL, INDIANA 46032 1235 N DELAWARE
0 1� INDIANAPOLIS IN 46202 CHECK NUMBER: 158704
CHECK DATE: 4/15/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343000 135.95 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS r GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM MAR `3
TO
(GOVERNMENTAL UNIT) T'
ON ACCOUNT OF APPROPRIATION NO. FOR ki,
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER
DATE FROM TO READING
AUTO 1,9LEAGE
NATURE OF BUSINESS MILES D. o, S
19 POINT POINT START FINISH TRAVELED
PER MILE
4 A S �o w F 14
(Zo w
t l
i
I i
a
3 od
cb
0
0
a
a o�
o�
Via I
a o�
AUTO LICENSE NO. TOTALS
SPEEDOMETER READING columns are to be used only when distance between points be determined by fixed mileage or official highway map.
i
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 .jaast credits
end that no part of the same has been paid.
Pate
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
L AGE CLAIM
OR 4 2CCg To
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER
DATE READING AUTO MILEAGE
NATURE OF BUSINESS MILES x
19 POINT POINT START FINISH TRAVELED PER MILE
a 6_016
�01
3 -1 -N
Y oy
1 0f
3 l •u `6
I ink {r: 1 w c✓ L^^� �I an�t;b
I -m _K� a ef b
-05 -oS
1- 08,
AUTO LICENSE NO. TOTALS 13-7
SPERDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
l�
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 a just credits
,and that no part of the same has 14een paid.
Da €e
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
Adam Wood Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s)) 66.76
3125108 reimb. Mil ea a reimbursement 69.19
4/4/08 reimb. Expense reimbursement
Total 135.95
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.
Adam Wood Allowed 20
In Sum of
135.95
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept
1046 reimb. 4343000 135.95 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
14 -Apr 2006
Sig cure
135.95 Business 4rvi p& Manager
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund