HomeMy WebLinkAbout159389 05/14/2008 0 a CITY OF CARMEL, INDIANA VENDOR: 360464 Page 1 of 1
`l. ONE CIVIC SQUARE LINDSAY HOLAJTER
CARMEL, INDIANA 46032 6628 BEAR CREEK DRIVE APT 1424 CHECK AMOUNT: $60.30
11 INDIANAPOLIS IN 46254 CHECK NUMBER: 159389
l CHECK DATE: 5/14/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4343000 60.30 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER AUTO AG
DATE FROM To READING -F NATURE OF BUSINESS MILES
ZO
POINT POINT START FINISH TRAVELED PER MILE
I 3
t 0 t
E5
i
viam m w 1-
0 vk f l 0 —4-. q
2 12 ML
KO Im Lao W
i ML
r
r
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Z Z� g-r m n G U _.r.._ 8
-3 03 lib l (Lr� fi n
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1 Qee!h �q u
i
AUTO LICENSE NO. TOTALS 9 Ll
SPEEDOMETER READING columns are to be used only when distance between points cannot be deterinined 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 legall due, after allowing all just credits
and thaw no pa t of the same has been paid.
Date
1
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form.
That it is duly authenticated as required
by law
That it is based upon statutory authority.
That it is apparently correct
incorrect
Disbursing Officer
On Account of Appropriation No. for
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Allowed 19 o w
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in the sum of b �V m M
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A.E. BOYCE CO., INC. MUNCIE, IN 01 In p t: lD
r 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.
Lindsay Holajter Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/24108 Reimb. Reimburse mileage 113108 4/17/08 60.30
Total I 60.30
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.
Lindsay Holajter Allowed 20
In Sum of
60.30
ON ACCOUNT OF APPROPRIATION FOR
101 -1125 GEN FUND
PO# or INVOICE NO. ACCT #!TITLE AMOUNT Board Members
Dept
1125 Reimb. 4343000 60.30 V 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
12 -May 2008
S!gUtur
60.30 Business ces Ma nager
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund