HomeMy WebLinkAbout179599 11/24/2009 CITY OF CARMEL, INDIANA VENDOR: 360144 Page 1 of 1
ONE CIVIC SQUARE CYNTHIA CANADA
CARMEL, INDIANA 46032 11508 LUCKY DAN DRIVE CHECK AMOUNT: $106.47
NOBLESVILLE IN 46060
CHECK NUMBER: 179599
CHECK DATE: 11/24/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343004 REIMB 106.47 TRAVEL PER DIEMS
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAC,E CLAIM r
To
(GOVERNMENTAL UNl'C)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OMCE, BOARD, DEP&MUNT OR INSrnUTION)
SPEEDOMETER AUTO W[M E
DATE FROM TO READING NATURE OF BUSINESS MILES Cdi I T
2 IOINT POINT START FINISH TRAVELED PER MILE t
173 L
iD
la
JV\ f
T r Q i
3
-at n1
Lf
in
G C I c
f� VZ1 ?i
Svc
D
AUTO LICENSE NO. TOTALS 5, C) y
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. Lo c q11
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregou)g account is just and correct, that the amount claimed is legally due, after aliowing all I
end that no part oJ the same has been paid.
Date
9/1! U
qs
3� Nov 3 2009
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORK NC. 101 (1986)
MILEAGE CLA
IM
(GOVERNMENTAL MY) C
ON ACCOUNT OF APPROP FO R
NO. FOR
(OFFICE, BOARD, DEPARTLM(T OR 1NSTRUnON)
DATE FROM TO I §-Pa ER AUTO MILEAGE
REA DING
NATURE OF BUSINESS N9LES
Za POINT POINT START FINISH TRAVELED PER MILE
Is VV)l 0 i CAL gr.
15 T m s a 7. 3
C
3,
r 3.
��E M D �n
n vo (1
iM T S
f Y-T ,'n C 5cha L'—T t' QQ
per cz c
m r
=<-o S. e_
r'i1,D I :a
GT Vh
r
m O
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 aliowing all just credits
end that no part Of the has been paid.
Date
(0 000S
A NOV 1 3 2009
-IAV�� 6 'Vl pro
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.
360144 Canada, Cyndi Terms
11508 Lucky Dan Dr
Noblesville, IN 46060
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
11/12/09 Reimb. Mileage 9/15 11/12/09 106.47
Total 106.47
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
20_
Clerk- Treasurer
Voucher No. Warrant No.
360144 Canada, Cyndi Allowed 20
11508 Lucky Dan Dr
Noblesville, IN 46060
In Sum of
106.47
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 106.47 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
which charge is made were ordered and
received except
19 -Nov 2009
Signature
106.47 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund