HomeMy WebLinkAbout167293 12/23/2008 a CITY OF CARMEL, INDIANA VENDOR: 361017 Page 1 of 1
ONE CIVIC SQUARE JENNY CHASTAIN CHECK AMOUNT: $63.04
CARMEL, INDIANA 46032 511 SECOND AVE NE
CARMEL IN 46032 CHECK NUMBER: 167293
CHECK DATE: 12123/2008
DEPARTMENT ACCOUNT P O NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1160 4343004 63.04 TRAVEL PER DIEMS
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
C 17-7' TO d
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPAOPRIATIQN NO. FOR
(OF CE, BOARD, DEPARTMENT OR INSTITUTION)
DATE FROM TO SPEEDOMETER READING AUTO MILEAGE
NATURE OF BUSINESS MILES I c
POINT POINT START FINISH TRAVELED MILE
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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, 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.
1� Date
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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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Presc•"�„d, by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rey. 1995)
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
Jenny Chastain Purchase Order No.
511 Second Ave NE Terms
Carmel in 46032 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/ 6/08 Milea e Loa, Reimbursement for mileage for Jenny Chastain
Total $6 3.04
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.
12119108
ALLOWED 20
J enn y Chastain IN SUM OF
511 Second Ave NE
Carmel TN 4032
63.04
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 $63.04 bill( is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
20
S nature
Title t
Cost distribution ledger classification if
claim paid motor vehicle highway fund