HomeMy WebLinkAbout167412 12/23/2008 CITY OF CARMEL, INDIANA VENDOR: 356305 Page 1 of 1
ONE CIVIC SQUARE DARRELL D NORRIS CHECK AMOUNT: $35.10
CARMEL, INDIANA 46032 101 2ND AVE SW, #2C
•ti;�_ M �o CARMEL IN 46032 CHECK NUMBER: 167412
CHECK DATE: 12/23/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBE AMOUNT DESCRIPTION
1160 4343004 35.10 TRAVEL PER DIEMS
I
I
PRESCRIBED BY STATE BOARD OF ACCOUNTS A GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
TO
AI x- Ia (IO EN NIT) i ,i j�
(/J) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING MILES
XL4 POINT POINT START FINISH NATURE OF BUSINESS TRAVELED s
PERM E
D o
CO U
AUTO LICENSE NO. TOTALS J�
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 part of the same has been paid.
Date
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
o W a
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Allowed 19 k x a
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Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
12/19/08 CITY OF CARMEL
An invoice or 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
Darrell Norris Purchase Order No.
r
One Civic Square Terms
Carmel IN 46032 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
19/17M Mileage Log Reimbursement to Darrell Norris for milenge 0
Total $35.10
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.
12/19/08
ALLOWED 20
Darrell Norris IN SUM OF
One Civic Squ
Carmel In 46032
35.10
ON ACCOUNT OF APPROPRIATION FOR
1160 Mayor 4343004
Travel per diem
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
Mileag Log 4343004 $35,10 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
20
Sigry��ure
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund