HomeMy WebLinkAbout170744 04/16/2009 CITY OF CARMEL, INDIANA VENDOR: 362749 Page 1 of 1
ONE CIVIC SQUARE KELSEY BLAKE
CHECK AMOUNT: $101.71
CARMEL, INDIANA 46032 13259 EASTWQOD LN
•o� FISHERS IN 46038 CHECK NUMBER: 170744
CHECK DATE: 411612009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343004 101.71 TRAVEL PER DIEMS
PRL'SCR(9ED BY STATE BOARD OF ACCOUNTS GtNERAL FORM NG. IN (14961
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATI O. FOR
(OFFICE, BOARD, DEPAATWDfT O9 INST7T7rr10N)
SPEEDOMETER AUTO MILEAGE
DATE
FROM TO I READING NATURE OF BUSINESS MM ES Cd 5 5 1
POINT POINT START FINISH TRAVELED PER MILE
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AUTO LICENSE NO. TOTALS
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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 1 gaily due, after alio'j, g all j Gs cDdits
end that no a of the a bas been paid.
Date (J
PRESCRIBED By STATE BOARD OF ACCOUNTS GENERAL FORM 11G. 761 [1406}
MILEAGE CLAIM 1;
ro N I
(GOVERNMENTAL UN111
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF acE, BOARD, DEPARr w" OP INSTITUTION)
SPEEDOMETER
DATE FROM Tp I BEADING NATURE OF BUSINESS WL B MIL EAGE
Fi c
2� POINT POINT START FINISH TRAVELED PER MILE
x
0
b
a, t c i�L4 I S J, rl �X
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1� L
U T
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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 forecoing account is just and correct, that the amount claimed is egally due, after aliowing a jus credits
end that no p rt of the syq been paid.
Date
I
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
ti
Purchase Order No.
Blake, Kelsey Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
3117109 Reimb. Mileage 12/11108 3112109 101.71
Total 101.71
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.
Blake, Kelsey Allowed 20
In Sum of
101.71
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT WTITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 101.71 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
8 -Apr 2009
Signature
101.71 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund