HomeMy WebLinkAbout168384 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: 358408 Page 1 of 1
0 ONE CIVIC SQUARE TIFFANY BUCKINGHAM
CARMEL, INDIANA 46032 5130 PRIMROSE AVE CHECK AMOUNT: $113.55
INDIANAPOLIS IN 46205 CHECK NUMBER: 168384
i CHECK DATE: 2/4/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBE AMOUNT DESCRIPTION
1046 4343000 REIMB 113.55 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD Of ACCOUNTS GENERAL FORM NO. 101 (1985)
MILEAGE CLAIM Q
,r
a s 1 i Rec c a. o V TO 1 i i ✓I Gt lna t
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
Y-5 L
(OHICE, BOARD. DEPARTIQNT OR INSTTTUrION)
FROM TO SPEEDOMETER AUTO Nn.EAGE
DATE I READING
NATURE OF BUSINESS MILES Try t
POINT POINT START FINISH TRAVELED PER MILE
L 2- N
Ilk
1 Z d vi l
t i r
ii L c1
IZ A G
tZ O �i --P C
1Z t �C
V�
i C
1 T o- c e c-T
C' 1 LO
c E o 5.iD
I
AUTO LICENSE NO. TOTALS 1 I
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 after aliowing all just credits
end that no part of the same has been paid.
Date
Y
CEI VED
JAN 2 6 2009
BY:
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An inv9,ice 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
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/22/09 Reimb. Mileage 12/2/08 1/22/09 Cherry Tree 113.55
Total 113.55
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.
35EA08 Buckingham, Tiffany Allowed 20
r In Sum of
113.55
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343000 113.55 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
2 -Feb 2009
Signature
113.55 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund