HomeMy WebLinkAbout180840 12/30/2009 (2) CITY OF CARMEL, INDIANA VENDOR: 361054 Page 1 of 1
ONE CIVIC SQUARE CHARLES A IMAN CHECK AMOUNT: $100.10
CARMEL, INDIANA 46032 11018 TAM C'SHANTER DR
CARMEL IN 46032 CHECK NUMBER: 180840
CHECK DATE: 12/30/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343004 100.10 TRAVEL PER DIEMS
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
C- P TO
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIA'T'ION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
DATE FROM TO SPEEDOMETER T +R AU MILEAGE
NATURE OF BUSINESS MILES c
19 PO POINT START FINISH TRAVELED PER MILE
174,0 AL?6Z, C/95
i
I
.G o I
r
r0/
N Al
0.
nFr 1 nnq
AUTO NO. TOTALS
L X
'3
SPEEDOMETER READING columns are to be used only when distance between points be determined by fixed mileage or official highway map. 1
V
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 claim 3 is legally due, after allowing all just credit
and that no part of e sa has been paid.
Da
Q
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILE,AGl's CLAIM
0ep(2— TO v
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER AUTO DATE FROM TO I READING MILES MILEAGE Q
19 POD POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MILE
d 1U 3
t`•
It lz
1
/3. 7 v .71 1 7
LS `7 AUTO LICENSE NO. TOTALS r L 1 M I r,E
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 due, arenffiowin4 all just credits
end that no part of the same has been paid.
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.
361054 Iman, Charles Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
12/1/09 Reimb. Mileage 10/2 11/24/09 100.10
Total 100.10
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
i
Voucher No. Warrant No.
Iman, Charles Allowed 20
361054
In Sum of
100.10
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO #or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 100.10 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
23 -Dec 2009
Signature
100.10 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund