HomeMy WebLinkAbout202222 09/27/2011 CITY OF CARMEL, INDIANA VENDOR: 365667 Page 1 of 1
E ONE CIVIC SQUARE ANDREW MEADOWS
CARMEL, INDIANA 46032 CIO ESE
CHECK AMOUNT: $54.54
CHECK NUMBER: 202222
CHECK DATE: 9/27/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343000 REIMB 54.54 'TRAVEL FEES EXPENSE
I
PRESCRIBCD BY STATE BOARD Of ACCOUNT5 GENERAL FORM NO. 101 (7RBE)
MILEAGE CLAIM
TO �t t11_? PesJ a t✓:
[GOVERNMENTAL UNITT
ON ACCOUNT OF APPROPRIATION ND_ FOR
(OFFICr, BOARD, DFIAAnZDa OR INST1TUrION)
FROM TO J SPEEDOMETER AUTO
MILEAGE
DATE I READING
NATURE OF BUSINE55 MILES Q
POINT POINT START FINISH TRAVELED PER MILE
�Tn o c OW?
i
a// I=
C 0A_
o C
C 3
K. Sr z m'
I'
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 loTegoing account is just and correct, that the amount claimed is legally due, after allowing all just credits
end that no pa o the Ime has been paid.
Date
Pon
SEPUi12�{� -1
n o
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.
Meadows, Andrew Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
7128111 Reimb Mileage 5131 7115111 54.54
Total 54.54
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.
Meadows, Andrew Allowed 20
In Sum of
54.54
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. A.CCT #/TITLE AMOUNT Board Members
Dept
1082 -1 Reimb 4343000 54.54 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
22 -Sep 2011
Signature
54.54 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund