HomeMy WebLinkAbout178638 10/28/2009 CITY OF CARMEL, INDIANA VENDOR: 358408 Page 1 of 1
ONE CIVIC SQUARE TIFFANY BUCKINGHAM
CARMEL, INDIANA 46032 5130 PRIMROSE AVE CHECK AMOUNT: $155.10
a. INDIANAPOLIS IN 46205 CHECK NUMBER: 178638
CHECK DATE: 10/28/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NU MBER AMOUNT DESCRIPTION
1046 4343004 155.10 TRAVEL PER DIEMS
PRESCRIBED BY STATE BOARD o,ACCOUNTS GENERAL FORM ~=101 (INS)
MILEAGE CLAIM
(GO�WMEKTAL UNIT) ov ACCOUNT o, APPROPRIATION NO. FOR
(OFFICE, B13AFD. DEPARTMENT OR INSTITUTION)
FROM SPEEDOMETER AUTO MILE
DATE TO READING NATURE OF BUSINESS MILES C5 I
POINT �O r NT START FINISH P6 MILE
TRAVELED
T T
Oil C)
®r� (net b4
13 11
AUTO LICENSE NO. TOTALS
aPc000wszEn aoxoma columns are to he used onl when a/ma"o° be/°.°" points cannot be a°,°""inea by fixed milea nrofficial highway map.
Pursuant /v the provisions and penalties n/ Chapter zss Acts eo.1 hereby certif that we/=en"i"n account m>""/and correct, that 'he amount claimed is legall a
and that "o part the same has been paid.
Date
r7#
OCT Y080
Kl
1'\�^°
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.
358408 Buckingham, Tiffany Terms
5130 Primrose Ave
Indianapolis, IN 46205
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
10/2/09 Reimb. Mileage 8/14 10/2/09 155.10
Total 155.10
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
'W -1
Voucher No. Warrant No.
358408 Buckingham, Tiffany Allowed 20
5130 Primrose Ave
Indianapolis, IN 46205
In Sum of
155.10
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 155.10 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
22 -Oct 2009
Signature
155810 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund