HomeMy WebLinkAbout204539 12/13/2011 CITY OF CARMEL, INDIANA VENDOR: 065950 Page 1 of 1
ONE CIVIC SQUARE DIANA CORDRAY
CARMEL, INDIANA 46032 11843 STONEY BAY CIRCLE CHECK AMOUNT: $185.64
CARMEL IN 46033 -9501
CHECK NUMBER: 204539
CHECK DATE: 12/13/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4340600 41.00 RECORDING FEES
1701 4343004 137.64 MILEAGE
1701 4343004 7.00 PARKING
Prescribed by State Board of Accounts General Form No. 101 (1955)
MILEAGE CLAIM
1x191 C J TO DR.
/t7 (Governmental Unit)
lJ On Account of Appropriation No. for
(Office, Board, Department or Institution)
DATE FROM TO
ODOMETER READING" NATURE OF BUSINESS AUTO MILES MILEAGE r5 S.
20,/ Point Point Start T Finish TRAVELED PER MILE
L r jVe
U r•w Lv i
M i t A 0 V S -1
o gzi f e -A fi o s� Ile 4 1 1407 d D V-de /0
-aJ d l r4 u Ap ;rx
—441 O?i AWN
9 n, e8 Ile x'71 r o l
C�-hn 2n� 5. I `t�`o�l �r'S Jotv>✓ c 3 33
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, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after
allowing all just c dits, and that n part of the same has been paid.
Date )3, �V�l 9� �-A
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or 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.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached inv e(s) or bill(s))
Total
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.
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
1 which charge is made were ordered and
received except
/4. 20
Signatur
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund