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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 L G A b ✓1 CT I hkwi C e- r G CT v y'x C c= v✓1v 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