HomeMy WebLinkAbout203880 11/21/2011 CITY OF CARMEL, INDIANA VENDOR: 364243 Page 1 of 1
ONE CIVIC SQUARE JORDAN HILL
CARMEL, INDIANA 46032 21477 ANTHONY RD CHECK AMOUNT: $84.92
NOBLESVILLE IN 46062 CHECK NUMBER: 203880
CHECK DATE: 11/21/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 84.92 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORL NO. 101 (1906)
MILEAGE CLAIM
c TO
-r�yE` PE 61' DIEM
IM N Da) AIXL� �.t.1Q 1 f �tT�l
(GOVERNMENTAL UNIT) �O9
't II/L
C �RM I ✓L f, E��Vn0t11 ON ACCOUNT OF APPROPRIATION NO. FOR
(OHICE, BOARD, DrPAATMaXT OR INSTTTUTION)
SPEEDOMETER AUTO E
DATE FROM TO READING NATURE OF BUSINESS MILES Q
POINT POINT START FINISH TRAVELED PEAS
W C00 rID •0 1 i -W 5
t W A -160, r r
&o n 0 Nc�
I
Ci d o
t f A-tolto 3.a i
u 6 S
tJ t rt woo IC 3.0 1. GCJ
0 1 •65
t W
^QqhA 0 6.
F
t 6
71 b u^on 3 -t
Aot
I
nop li
AUTO LICENSE NO. TOTALS
Q
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. 13129
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due 4fi$r aliowing all just credits
end that no part of the same has been paid.
Date
84RA
NOV 14 201 J
a
Dyo
PRPSCRIBCD HY STATE BOARD Of ACCOUNTS
GENFAAL FORM I.O. 101 (106)
S MILEAGE CLAIM TRAVEL— P DIEM —A I 434300!�-
TO (OOVER"ENTAL UNIT} f .,J A{' \A 1 um, 1&4UJJMEg1::
C rk9_MEL 12EGITIDh1 ON ACCOUNT OF APPROPRIATION NO. FOR
(OHICE, BOARD, DEPA.M[Dff OR INSttrUTION)
DATE FROM TO S PEEDOMET
NG AUTO AG
PONT POINT START FINISH NATURE OF BUSINESS TR a�+ J
PER MILE
0 1 Wo td Il lsj a 3 b
r0 On 3.0
.Q
q I -W .O sv
►5 ►I o. '°.O to
I to i l rO o MO
I ►f_.
4 a 1 6 r MK
�1 l rlo a Z;' 1. is
oZ it
g I► is 11 W. 3 O 5
q/ 01(a/ it coD 3•u I.1b5
D 1 5
3• i•(o5
.o Li �S
.p
1 3.0
ems+ r -AAA ^-n
n r 4�5
AUTO LICENSE NO. TOTALS 75
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
i NOV 4 2011
DYo
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.
364243 Hill, Jordan Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
11/14/11 Reimb Mileage 8/9 11/8/11 84.92
Total 84.92
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.
364243 Hill, Jordan Allowed 20
In Sum of
84.92
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
Reimb 4343000 84.92 1 hereby certify that the attached invoice(s), or
Qgf 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
17 -Nov 2011
Signature
84.92 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund