HomeMy WebLinkAbout164276 09/30/2008 CITY OF CARMEL, INDIANA VENDOR: 360464 Page 1 of 1
ONE CIVIC SQUARE LINDSAY HOLAJTER
4 CARMEL, INDIANA 46032 6628 BEAR CREEK DRIVE APT 1424 CHECK AMOUNT: $52.28
INDIANAPOLIS IN 46254 CHECK NUMBER: 164276
CHECK DATE: 9/30/2008
D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4343000 52.28 TRAVEL FEES EXPENSE
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PRESCRIBED By STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1486)
MILEAGE CLAIM I /U
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF'F'ICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO i SPEEDOMETER AUTO MILEAGE
DAW READING NATURE OF BUSINESS MILES
POINT POINT START FINISH TRAVELED PER MILE
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AUTO LICENSE NO. TOTALS 3�.y
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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
and that no art of the same has been paid.
Date
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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.
360464 Holajter, Linday Terms
6628 Bear Creek Dr., Apt 1424 Date Due
Indianapolis, IN 46254
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/16/08 Reimb. Mileage 6/6/08 8/20/08 52.28
Total 52.28
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
i
Voucher No. Warrant No.
360464 Holajter, Linday Allowed 20
In Sum of
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52.28
ON ACCOUNT OF APPROPRIATION FOR
101 -General Fund
PO# or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept
1125 Reimb. 4343000 52.28 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
17 -Sep 2008
Signature
52.28 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund