HomeMy WebLinkAbout204826 12/20/2011 CITY OF CARMEL, INDIANA VENDOR: 358411 Page 1 of 1
i ONE CIVIC SQUARE JENNIFER HAMMONS
CARMEL, INDIANA 46032 634 NORTHVIEW AVENUE CHECK AMOUNT: $251.97
INDIANAPOLIS IN 46220 CHECK NUMBER: 204826
CHECK DATE: 12/20/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 251.97 TRAVEL FEES EXPENSE
PR[SCRIBED BY STATE BOARD Or ACCOUNTS GURRAL FORM RO, 10) (1986)
MILEAGE CLAIM
TO V II LL gll +tt
1flO9EMMENTAL T
ON ACCOUNT OF APPROPRIATION NO. FOR
10i7C£, t10ARD, DEPAR7WNr OR 1NSr[rifrLos)
SPEEDOMETYR AUTO SAGE
DATE FROM To READING t NATURE OF BUSINESS MILES c
20 pOINT POINT START FINISH 1 "AAV£LSD PER MILE
14JL I m S
WC Mrv�w� W l le
1 O 1�ry.c4
C c c—
AUTO LICENSE NO. TOTALS
t
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 aliowing all just credits,-
and that no art of th L same has been paid.
Date t q3q.P-0
7
I
DEC 1011 e
A
J
PRESCRIBED BY STATE BOARD OF ACCOUNTS MILERGE CLAIM GENERAL FORM 140. 101 0"Stl
To C� S
IGOVERNMENTAL UNIn ON ACCOUNT OF APPROPRIATION NO. FOR
(OFiYCE, BOARD, DEPARTMENT OR INSnn7r101K)
SPEEDOMETER AUTO AQ_LEAGE
BUSINESS MI
DA T£ FROM TO I READING NATURE OF LES 6 SS I
POINT POINT START FINISH TRAVELED PER WL
Lk
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l
I A L
Ll
V S
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i ell. L CA
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rte I chn
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10 L= C C
O. Q
LICENSE N TOTALS I S
AUTO LIC
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 d e, after aliowing all just credits
and that no pa of thLe� same has been paid.
Date
r q� q
DEC 1 i!
1011
,T
rX IL 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.
358411 Hammons, Jennifer Terms
634 Northview Ave Date Due
Indianapolis, IN 46220
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
12/14111 Reimb. Mileage 9/2 12/15/11 251.97
Total 251.97
1 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.
358411 Hammons, Jennifer Allowed 20
634 Northview Ave
Indianapolis, IN 46220
In Sum of
251.97
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1 081 -10 Reimb. 4343000 251.97 f 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
15 -Dec 2011
Signature
251.97 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund