HomeMy WebLinkAbout204003 11/21/2011 CITY OF CARMEL, INDIANA VENDOR: 364943 Page 1 of 1
ONE CIVIC SQUARE VICKI RUBIO CHECK AMOUNT: $78.07
CARMEL, INDIANA 46032
"k rod CHECK NUMBER: 204003
CHECK DATE: 11/21/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 78.07 TRAVEL FEES EXPENSE
GENT.RAL FORM NC.]C-0 (19861
pxeSCRIBit) BY STATE BOARD Or ACCOUNTS
MILEAGE CLAIM
"n` y .NtALUNITI ON ACCOUNT OF APPROPRIATION NO. FOR
I0r}7CE, BOARD. EP&an6 17 OR INS rTUTION)
FROM TO S
ER A UTO AEL�EAG7E
DATE NATURE OF BUSINESS TRAVELED
Za POINT POINT START FINISH PER MILE
Gam` I t
I
ib
U 14
A
O a it. -tt �9 MCC, S
e t
C. I'
1
AUTO LICENSE NO- TOTALS l S
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is le ally due, after 'owing all just credits r
end that no part of the same has been paid_
Date
TM �'M %7 TV
J
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
364943 Rubio, Vicki Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
10/31/11 Reimb Mileage 1013 10/31/11 78.07
Total 78.07
I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
1 20
Clerk Treasurer
Voucher No. Warrant No.
364943 Rubio, Vicki Allowed 20
In Sum of$
78.07
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #MTLE AMOUNT Board Members
Dept
1081' -3 Reimb 4343000 78.07 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
17 -Nov 2011
Signature
78.07 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund