HomeMy WebLinkAbout202234 09/27/2011 CITY OF CARMEL, INDIANA VENDOR: 361086 Page 1 of 1
0 ONE CIVIC SQUARE JACOB C MOORE
CARMEL, INDIANA 46032 34BATHERTON DR CHECK AMOUNT: $37.19
CARMEL IN 46032 CHECK NUMBER: 202234
CHECK DATE: 9/27/2011
D EPARTMENT ACCOUNT PO NUMBER IN VOICE N UMBE R AMOUNT DESCRIPTION
1081 4343000 REIMB 37.19 TRAVEL FEES EXPENSE
PRESCRIBED HT STATE HOARD OF ACCOUNTS GENERAL FORM 110. 10) (ING)
MILEAGE CLAIM QCfj
TO
(GOVERNMENTAL UNITY ON ACCOUNT OF APPROPRIATION NO. FOR
{OFiICE. BOARD, DEPARTMENT OR INSnTLTION)
FROM TO READING AUTO 11ILF,AG _E
DATE I RAIN
NATURE �E--
OF BUSINESS Mn-ES
POINT POINT START FINISH TRAVELED PEA HI LE
IL
it
2
0 IA 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. 3 r 9 pW
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 aliowing all just credits f
end that no part of the same has been paid.
Date—
f D1
z �l SEA' ..1 2U1
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.
361086 Moore, Jacob Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
9!13111 Reimb. Mileage 819 9/13/11 37.19
Total 37.19
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.
361086 Moore, Jacob Allowed 20
In Sum of
37.19
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -1 Reimb. 4343000 37.19 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
37.19 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund