HomeMy WebLinkAbout206138 02/14/2012 CITY OF CARMEL, INDIANA VENDOR: 363096 Page 1 of 1
ONE CIVIC SQUARE MICK BARTON
0 CHECK AMOUNT: $4.99
CARMEL, INDIANA 46032
CHECK NUMBER: 206138
CHECK DATE: 2/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 4.99 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1966)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING
C� —RQ—�� POINT I POINT START I FINISH NATURE OF BUSINESS TRAVELED
PER MILE c
1 e U��v� I d,/to./� J�13 i la. ,s,(w(�_
4
1
i
I
i
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.
j 'g
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing, account is just and correct, that thi amount claimed is legally due, after allowing all just credits
and that no part of the same has been paid. -I I JAN 2 7 2012 t lC
Date fl`b �—`"I 1 _7 D
BY:
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.
363096 Barton, Mick Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1125112 Reimb Mileage 12/28/11 4.99
To 4.99
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.
363096 Barton, Mick Allowed 20
In Sum of
4.99
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept
1081 -99 Reimb 4343000 4.99 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
9 -Feb 2012
Signature
4.99 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund