HomeMy WebLinkAbout206337 02/14/2012 CITY OF CARMEL, INDIANA VENDOR: 364002 Page 1 of 1
�4� ONE CIVIC SQUARE ASHLEY LIVINGSTON CHECK AMOUNT: $104.34
?a CARMEL, INDIANA 46032 3404 WOODFRONT PLACE
INDIANAPOLIS IN 46222 CHECK NUMBER: 206337
CHECK DATE: 2/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 104.34 TRAVEL FEES EXPENSE
PRESCRIBED By STATE BOARD OF ACCOUNTS GENUAL FORM NQ 101 11986)
MILEAGE CLAIM
ro
rAL uNlrt ON ACCOUNT OF APPROPRIA ION NO. FOR
(OFFICE, BOARD. DEFKATNEEKT OR INST=ION)
FROM TO I SPEEDOMETER
READING AUTO
MILES
2� POINT POINT START FINISH NATURE OF BUSINESS TRAVELED J
DATE
PER MILE
t
JI a!
n
o I
AUTO LICENSE NO. TOTALS J
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Y
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 du a er allowing all just credits
and that no part of the same has been paid.
Date
1
l o t)( 1 0 J90-PERV 8;
JAN 2 o 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.
364002 Livingston, Ashley Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1/17/12 Reimb Mileage 12/12/11 1/17/12 104.34
Total 104.34
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.
364002 Livingston, Ashley Allowed 20
In Sum of
104.34
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or Board Members
Dept INVOICE NO. ACCT #/TITLE AMOUNT
1081 -2 Reimb 4343000 104.34 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
104.34 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund