HomeMy WebLinkAbout206273 02/14/2012 CITY OF CARMEL, INDIANA VENDOR: 360926 Page 1 of 1
ONE CIVIC SQUARE SHAVONNE HOLTON CHECK AMOUNT: $220.89
CARMEL, INDIANA 46032 3707 N MERIDIAN ST APT 3B
off INDIANAPOLIS IN 46208 CHECK NUMBER: 206273
CHECK DATE: 2/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 220.89 TRAVEL FEES EXPENSE
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PRESCRIBED HT STATE BOARD Or ACCOUNTS GENFAAL FORT/ 11C- 101 (19867
MILEAGE CLAIM
TO
1 YERNM ENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO- FOR
(OFFICE, HOARD, DUARTW3WT OR 11MSTnUr10N)
SPEEDOMETER
DATE FROM TO I READING •1 AV TO 11II,EA.GE
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AUTO LICENSE NO- TOTALS 1 5
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 claim eq 1 d a, aft iio&ng all just credits
end that n part of the same has been paid.
Date
1. JAN 0 20
�f 12
BY..
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PALSCAIBID BY STATE BOARD OF ACCOUNTS
GENFROLL FOR No 301 0
MILEAGE CLAIM
TO
(OOVEAN UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF, BOARD. DEPAAT14ENT OR INSTRVLION)
SPEEDOMETER
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AUTO LICENSE NO- TOTALS 1
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 certiy that the foregoing account is just and correct, that the amount clai is e y rJAIV a owing all just credits
end that no part of the same has been paid.
Date 1 0/ 12
20 2012
PAES[FIRED ITT STATE BOARD Or ACCOUNTS GENERAL FORM NC. 101 11996)
MILEAGE CLAIM
TO
(OOVERRNEIITAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE. HOARD. DUARTI@R OR INSTr"LON)
SPEEDOMETER
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'�:4V'f0 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, ACES 1853, I hereby certify that the foregoing account is just and correct, that the amount claim it g l ue, ft r Lowing all just credits
end that art o the same has been paid.
Date
Op \-QS
JAN
2 0 2012
PRCSCRIBCD By STATE BOARD OF ACCOUNTS GENERAL FORH 1 +c. 1P1 (Ivan
MILEAGE CLAIM���
TO
(OO9CANNENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFZOC, BORRO. DUAAT)glFf OA 7N57TNr10N)
SPEEDOMETER
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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 foregoing account is just and correct, that the amount claimed is-leg 11 due, r a owing all just credits
end that no part of the same has been paid.
Date
FEB 0 2 2012
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.
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
1116112 Reimb. Milea e 7120 12/30/11 183.15
1130112 Reimb. mileage 113 1/30112 37.74
Totai 220.89
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
Indianapolis, IN 46260
In Sum of
220.89
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -1 Reimb. 4343000 183.15 1 hereby certify that the attached invoice(s), or
1081 -1 Reimb. 4343000 37.74 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
220.89 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund