HomeMy WebLinkAbout204735 12/20/2011 CITY OF CARMEL, INDIANA VENDOR: 365412 Page 1 of 1
ONE CIVIC SQUARE MAUREEN CALLAHAN
i
CARMEL, INDIANA 46032 14529 SADDLEBACK DRIVE CHECK AMOUNT: $61.00
CARMEL IN 46032 CHECK NUMBER: 204735
CHECK DATE: 12/20/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1160 4343004 MILEAGE 61.00 TRAVEL PER DIEMS
PRESCRIBED Y STATE BOARD OF ACCOUNTS
GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM S Q-C�
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`4 n '-P 5� r�� �I TO
(GOVERNMENTAL UNIT) 60
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER
FROM TO AUTO MILEAGE
DATE f 'READING NATURE OF BUSINESS MILES a Q
I k POINT POINT START FINISH TRAVELED
PER MILE
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A TO LICENSE NO. TOTALS
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileaqe 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 aliowing all just credits
and that no part of the same has been paid.
Date
s
Claim No. Wanmxo I examined ±ewtEnd6maahmb
I FAVOR OF certify as follows:
That aaa proper form.
That aa duly authenticated m required
by law
That it Bbased upon statutory a ±or y
That a6apP «e !7! ƒcorrect
incorrect
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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 invoice(s) or bill(s))
12/16/11 Mileage Claim $61.00
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.
Maureen Callahan ALLOWED 20
IN SUM OF
14529 Saddleback Drive
Carmel, IN 46032
$61.00
ON ACCOUNT OF APPROPRIATION FOR
Mayor's Office
PO# I Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1160 Mileage Claim 43- 430.04 $61.00 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
Friday, December 16, 2011
Ma or
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund