HomeMy WebLinkAbout199031 07/06/2011 CITY OF CARMEL, INDIANA VENDOR: 365463 Page 1 of 1
ONE CIVIC SQUARE MATTHEW GREGORY
CARMEL, INDIANA 46032 C/O ESE CHECK AMOUNT: $214.97
CHECK NUMBER: 199031
CHECK DATE: 7/6/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 214.97 TRAVEL FEES EXPENSE
PRLSCRIB£D BY STATE BOARD OF ACCOUNTS GENERAL FORM NG. 101 (1986)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNM ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPAR71CiNT OR )NSITrUTION)
SPEEDOMETER AUTO MILEAGE
FROM TO READING MILES Q
DATE NATURE OF BUSINESS
Zo POINT POINT START FINISH TRAVELED PER MILE
t
5 T- 4t %f►t�
1 3 s`
S
A e l f It
3 IT7
I
AUTO LICENSE NO. TOTALS qq *9
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 aliowing all just credits
and that no part of the same has been paid.
Date
U l; L9
J UN 2 1011
BY:
GENERAL FOAM NO. 101 (1986)
PRESCRIBED BY STATE BOARD OF ACCOUNTS
MILEAGE CLAIM
TO
(GOVERNMENTAL UN1T1 ON ACCOUNT OF APPROPRIATION NO. FOR
(OiiTCE, HOAPD, DEPAA'n(FNr OR 1N5r[TVr108)
SPEEDOMETER AGE
DAT FROM TO READING NATURE OF BUSINESS A MII ES cy Uri
2 J POINT i POINT START FINISH TAAVELED PER MILE
1 PT In
w� z
1% Y
e
S
!�1 M
1 7 15
T 6 7
D
/t D
r a ll K
or
y ki
r
F Pn o
3 S7
T
PT-- w
6 O F
o A6 I
TOTALS
AUTO LICENSE NO.
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 le ally due, after aliowing all just credits
and that no pail of the same has been paid. Aalx�
Date 1 0 I I
Ca
JUN 2 12011
BY:
.E.F., rOPM NC. IG 'm6)
PMCRIB ED BY STATE BOARD OF ACCOUNTS
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT} ON ACCOUNT OF APPROPRIATION NO. FOR
SPEEDOMETER AUTO MILEAGE
DATE FROM TO READING NATURE OF BUSINESS MILES 6
E--
POINT FONT START FINISH TRAVELED PER MILE
A ('Y
re-b o -61
FA, 7
P Vh 0 h 0
11 F "r op
A A 11 PT
P r rm n f N&
'D -7-
1 7
PT a kt, r A-y
�ep VK
MA in t a�Lf -7
V% S
-'Mr
r T VAr"Vk%
j"
U
A
me' Ao A
�S'77
S
3 15
j 1
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, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after aliowing all just credits
and that no part of the same has been paid.
Date 3 L/ I/
17-1
q
JUN 2 2011
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.
Gregory, Matthew Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
5/27/11 Reimb Mileage 2/22 5/27/11 214.97
Total 214.97
I 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.
Gregory, Matthew Allowed 20
In Sum of
214.97
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
Board Members
PO# or INVOICE NO. CCT #/TITL AMOUNT
Dept
1081 -7 Reimb 4343000 214.97 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
28 -Jun 2011
Signature
214.97 Accounts Payabl Coordina
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund