HomeMy WebLinkAbout203933 11/21/2011 CITY OF CARMEL, INDIANA VENDOR: 364002 Page 1 of 1
ONE CIVIC SQUARE ASHLEY LIVINGSTON
i CHECK AMOUNT: $104.90
CARMEL, INDIANA 46032 3404 WOODFRONT PLACE
INDIANAPOLIS IN 46222 CHECK NUMBER: 203933
CHECK DATE: 11/21/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 104.90 TRAVEL FEES EXPENSE
^x.ESCRIBED ET STATE BOARD Or ACCOUNTS CENVIAL FORM 11G. 101 (1986}
MILEAGE CLAIM
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SPEEDOMETER AUTO AGE
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zo t NATURE OF BUSINESS MILES L�, E ms—
POINT POINT START FINISH TRAVELED PER MILE
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AUTO LICENSE NO. TOTALS PIL�_
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. f
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 t
and that no part of the game has been paid.
Date
dE N0- 3 2011
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.
364002 Livingston, Ashley Terms
Invoice gInvolce Description Amount
D (or note attached invoices) or bill(s))
PO
10/17/11 Mileage 9/14 10/17/11
104.90
Total 104.90
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.
364002 Livingston, Ashley l Allowed 20
f
V
In Sum of
F
104.90
i
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITL AMOUNT Board Members
Dept
1081 -2 Reimb 4343000 104.90 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
a
received except
II
17 -Nov 2011
Signature
104.90 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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