HomeMy WebLinkAbout179702 11/24/2009 CITY OF CARMEL, INDIANA VENDOR: 360926 Page 1 of 1
ONE CIVIC SQUARE SHAVONNE HOLTON CHECK AMOUNT: $36.85
CARMEL, INDIANA 46032 3707 N MERIDIAN ST APT 3B
INDIANAPOLIS IN 46208 CHECK NUMBER: 179702
CHECK DATE: 11/2412009
DEPARTM AC PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343004 REIMB 36.85 TRAVEL PER DIEMS
i
ppISCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 11906)
MILEAGE CLAIM V
TO (GOVERNMENTAL UNIn ON ACCOUNT OF APPROPRIATION NO. FOR N 3 vv
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(OFiICP, BOARD, DEPART6Q]IT OR iNSTr[U'IION)
SPEEDOMETER
D
FROM AUTO MILEAGE Ta READING f NATURE OF BUSINESS MILES (y e
2 POINT POINT START FINISH TRAVELED PER MILE
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r r
JES
Z O
r G t
iM
2
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 ioregoing account is just and correct, that the amount claimed lly no, ter allowing all just credits
end that no part of toe same has been paid.
Date log
NOV 13 2009
Ur
l N"
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.
I
Payee
Purchase Order No.
360926 Holton, Shavonne Terms
8001 Canary Ln Apt A Date Due
Indianapolis, IN 46260
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
11/10/09 Reimb. Mileage 10/1 10/30/09 36.85
Total 36.85
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.
360926 Holton, Shavonne Allowed 20
8001 Canary Ln Apt A
I Indianapolis, IN 46260
In Sum of
36.85
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 36.85 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
19 -Nov 2009
Signature
36.85 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund