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174777 07/22/2009 CITY OF CARMEL, INDIANA VENDOR: 360144 Page 1 of 1 ONE CIVIC SQUARE CYNTHIA CANADA CHECK AMOUNT: $125.17 CARMEL, INDIANA 46032 11508 LUCKY DAN DRIVE NOBLESVILLE IN 46060 CHECK NUMBER: 174777 CHECK DATE: 7/22/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 3.046 4343004 REIMB 125.17 TRAVEL PER DIEMS PRESCRIBED BY STATE BOARD Or ACCOUNTS GENERAL FORM NG. 101 114857 T MILEAGE CL TO q(\ C A A C (GOVERNMENTAL UNITE ON ACCOUNT OF APPROPRIATION NO. FOR (OF, BOARD, DEPARTMENT OR INSTMITION) TER DATE FROM TO I S READ NG AUTO MILEAGE POINT PONT START FINISH NATURE OF BUSINESS TRAVELED PER MILE n r� i C A. I I L l r ,h'T C> YhJ 11 J� l I HT GG� Q A4� 4 N J r rl I AUTO LICENSE NO. TOTALS PS o I OC LJ. 1 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 t e same has been paid. Date S ,a J u 2 zoos dy 15 I �l ';r PRESCRIBED BY STATE BOARD OF ACCOUNTS GENEPALiOAN 140. I01 (1406) MILERGE CLAIM n (GOVERNMENTAL UNl'n ON ACCOUNT OF APPROPRIATION NO. FOR (Oi7C£, HOA PD, OEPAATME7fT OR INST(TIn108) SPEEDOMETER DATE FROM TO READING AUTO 9MEAGE 2° NATURE OF BUSINESS POINT POINT START FINISH TRAVELED PER MIE n n ro C� S m c r C M 1M 1 r n S a- t"rl -1 C\ A- r rl\ l-tD t M M �11 �r1 5 1 �1 I 1 r_ 3 5 7 O 53 3 5 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 and that no part of Te same...,,, has been paid. Date s 1111-1` J k� 1- PRESCRIBED BY STATE BOARD Of ACCOUNTS GENERAL FORM NO. 10) 11986) MILEAGE CLAIM TO (GOVERNMENTAL UVIn ON ACCOUNT OF APPROPRIATION NO. FOR (Or10E, BOARD, DEPAATl@fi OR INSTTMION) FROM TO SPEEDOMETER AUTO MILEAGE DATE I READING ES a POINT POINT START FINISH NATURE OF BUSINESS TRAVE ED r PER MILE C Ion. T� rn ro I. rfy) �'U V O r F rV A 0 t Q t� F r I. L her r le- re c-1 1l 1� S f.2 C> V- m r 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 laof t}Ie© has been paid. p Date LSD S/ 4 JUL 0 2 2009 b 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 6/25109 Reimb. Mileage 4/30/09 6/23/09 125.17 Total 125.17 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 125.17 ON ACCOUNT OF APPROPRIATION FOR 104 Program Fund PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1046 Reimb. 4343004 125.17 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 16 -Jul 2009 Signature 125.17 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund