HomeMy WebLinkAbout199051 07/06/2011 CITY OF CARMEL, INDIANA VENDOR: 360926 Page 1 of 1
ONE CIVIC SQUARE SHAVONNE HOLTON
CARMEL, INDIANA 46032 3707 N MERIDIAN ST APT 38 CHECK AMOUNT: $53.55
INDIANAPOLIS IN 46208 CHECK NUMBER: 199051
L�roN -p
CHECK DATE: 7/6/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 53.55 TRAVEL FEES EXPENSE
GENERAL FOAM NO. 101 OWS)
PRESCRIBED BY STATE BOARD OF ACCOUNTS
MILEAGE CLAIMe:�1
(GOVERNMENTAL, UNIn ON ACCOUNT OF APPROPRIATION NO- FOOR
toFACE, BOARD. DEPAAMNT OR INSTITITTION)
SPEEDOMETER AUTO S
DATE FROM TO i READING NATURE OF BUSINESS MILES NATURE
POINT POINT START FINISH PER MILE
i
1 3
Z
22
O
t
AUTO LICENSE NO- TOTALS
6a �C�(o0.
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 ue, er liowing all just credits r
end that n patio the same has been paid.
Date
I_-
JUN 201
BY:
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 110. 101 (1986)
MILEAGE CLAIM
(GOVEAMMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OHICE, BOARD, DEPARTMENT OR INSTTnniON)
SPEEDOMETER
DATE FROM TO I READING AUTO _E E c
NATURE OF BUSINESS TRAVELED
z� POINT POINT START FINISH
PER MILE
I --1 3-
15 1
5
I
I, 5
or 1 3
i
3
r wo c S
It
AUTO LICENSE NO. TOTALS Z 2 CI
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. J
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 claime7ally allowing all just credits
end that nq pa; q\I; same has been paid.
Date f hC`/
i 2 3 20n
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.
360926 Holton, Shavonne Terms
8001 Canary Ln Apt A Date Due
Indianapolis, IN 46260
Invoice Invoice Description
Date Number
or note attached invoice(s) or bill(s)) PO Amount
6121111 Reimb. Mileage 311 4125111
53.55
Total 53.55
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.
360926 Holton, Shavonne Allowed 20
8001 Canary Ln Apt A
Indianapolis, IN 46260
In Sum of
53.55
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -1 Reimb. 4343000 53.55 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
�"Z1721Z
Signature
53.55 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund