HomeMy WebLinkAbout177125 09/15/2009 CITY OF CARMEL, INDIANA VENDOR 358408 Page 1 of 1
z ONE CIVIC SQUARE TIFFANY BUCKINGHAM CHECK AMOUNT: $164.45
CARMEL, INDIANA 46032 5130 PRIMROSE AVE
4; row a INDIANAPOLIS IN 46205 CHECK NUMBER: 177125
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CHECK DATE: 911512009
DEPA RTMENT AC P NUMBE INVOICE NUMBER AMOUNT DESCRIPTION
104.6 4343004 164..45 TRAVEL PER DIEMS
PRESCRIM ET STATE 60ARE) OF ACCOUNTS GENERAL FORM NO. 101 (10861
MILEAGE CLAIM
(GOVFANMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFYICE. BOARD. DEPART KIM OR INSTlTV71ON1
r SPEEDOMETER FROM TO ji SPEEDOMETER i AUTO I MILEAGE
za MILES C
NATURE OF BUSINESS l
POINT POINT START FINISH TRAVELED €i PER MILE
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AUTO LICENSE NO- TOTALS VI U
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
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Pursuan! 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 the same has been paid.
Date
J o� -7,
AUG 2 6 2009
1. x�
ACCOUNTS PAYABLE VOUCHER
r 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.
Terms
358408 Buckingham, Tiffany
5130 Primrose Ave
Indianapolis, IN 46205
Invoice Invoice Description PO Amount
Date Number (or note attached invoice(s) or bill(s))
164.45
8126/09 Reimb. Mileage 5129 8112109
Total 164.45
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.
358408 Buckingham, Tiffany Allowed 20
5130 Primrose Ave
Indianapolis, IN 46205
In Sum of
�v
164.45
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #MTLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 164.45 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
10 -Sep 2009
Signature
164.45 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund