HomeMy WebLinkAbout202132 09/27/2011 CITY OF CARMEL, INDIANA VENDOR: 355994 Page 1 of 1
ONE CIVIC SQUARE PAMELA GRIFFITHS
CARMEL, INDIANA 46032 CHECK AMOUNT: $113.00
12906 DOUBLE EAGLE DRIVE
CARMEL IN 46033 CHECK NUMBER: 202132
CHECK DATE: 9/27/2011
DEPARTMENT ACCOUNT PO NUMB INVOICE NUMBER AMOUNT DESCRIPTION
1202 4343002 113.00 MILEAGE
Prescribed by State Board of Accounts General Form No. 101 (1955)
MILEAGE CLA►lilfll
TO DR.
(Governmental Unit)
On Account of Appropriation No. for
(Office, Boar Department or institution
DATE FROM TO ODOMETER READING" NATURE OF BUSINESS AUTO MILES MILEAGE
0 j Point Point Start Finish TRAVELED PER MILE
a 7
P Cl C 4 C -C D �r C' Li �r i, 3Tacc c -L e o �e
a7 1 U44 216 Co LL. -3466 J3J0r- D& Ci r 6 P r 4.7m a C, LL
d c C o Unlr 1_ a tr '.3 C 9
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Auto License No. U TOTALS 4) 31
SPEEDOMETER READING columns are to be used only when distance between points cannot btdeter ine�1 fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155 Acts 1953 1 hereby certify that a fo.e oin c A4 T t is 'u t and correct, that the amount claimed Is le all due, after
P P P Y fY Tg, 90
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allowing j t credits, and that no part of the same has been paid
Date 7 �-1 C
i3y
Claim No. Warrant No._ 1 nave examined the within claim and
hereby certify as follows:
IN FAVOR OF
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
On Account of Appropriation No. for
Disbursing Officer
O
Allowed 20 Q
ti
in the sw of o
(2 (D
0
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0
(Barad or Commission)
((D O
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rt
(Offima Title)
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Prescribed by State Board of Accounts I General Form No. 101 (1955)
MILEAGE CLK11A
TO DR.
(Governmental Unit)
On Account of Appropriation No. for
(Office, Board, Department or Institution
DATE FROM TO
ODOMET R READING` NATURE OF BUSINESS AUTO MILES MILEAGE
20 Point Point Start 1 Finish TRAVELED PER MILE
/D I, if s 1, L CC C C S l r14 ✓E ?G r r'o q kn e'M
3 7 b ,'V C t i I E u D
Cl I G '50 k4 At- [L &Adr L yy C -dir We
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Auto License No. II j TOTALS Zo 55 X11. 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, 1 hereby certify that the foregoing accour,`it 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 U
S` 2 6' 2011
By
Claim No. Warrant No. I have examined the within claim and
hereby certify as follows:
IN FAVOR OF
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
On Account of Appropriation No. for
Disbursing Officer
a (D
Allowed 20 (D
0 C
Q N
in the sum of O
"(D
N o (D
(D
�(D�
CD
(Board or Commission) 0
Q
(D
FILED
5
CD�
o
Q
N
(Official Title) 9
r.
N O
O N U
VOUCHER NO. WARRANT NO.
ALLOWED 20
Pam Griffiths
IN SUM OF
$113.00
ON ACCOUNT OF APPROPRIATION FOR
IS Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT
Board Members
1202 09.15.11 43- 430.02 $71.69 I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
1202 09.15.11 43- 430.02 1 $41.31
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, September 26, 2011
irector I
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
09/15/11 09.15.11 $71.69
09/15/11 09.15.11 $41.31
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