HomeMy WebLinkAbout204168 12/06/2011 CITY OF CARMEL, INDIANA VENDOR: 358408 Page 1 of 1
f ONE CIVIC SQUARE TIFFANY BUCKINGHAM
o CARMEL, INDIANA 46032 5130 PRIMROSE AVE CHECK AMOUNT: $122.65
INDIANAPOLIS IN 46205 CHECK NUMBER: 204168
CHECK DATE: 12/6/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 122.65 TRAVEL FEES EXPENSE
PRESCRIBED By STATE BOARD OF ACCOUNTS GENERAL FORM 110. 101 (1786)
MILEAGE CLAIM
LPG
(GOVERNMENTAL UNI1T
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEFARTKENT OR INSTRVriON)
SPEEDOMETER 3
FROM TO AUTO �,4IL.AG1.- S!
DATE I READING -4�
l NATURE OF BUSINESS MtL� Cd
POINT POINT START FINISH TRAVELED PER MILE 1
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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, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after aiiowing all just credits
and that no part of the same has been paid.
Date
id 1 -y h
�a>r
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.
358408 Buckingham, Tiffany Terms
5130 Primrose Ave
Indianapolis, IN 46205
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
11/23/11 Reimb. Mileage 10/14 11/23/11 122.65
Total 122.65
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.
358408 Buckingham, Tiffany Allowed 20
5130 Primrose Ave
Indianapolis, IN 46205
In Sum of
122.65
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -2 Reimb. 4343000 122.65 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
1 -Dec 2011
Signature
122.65 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund