HomeMy WebLinkAbout168567 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: 355569 Page 1 of 1
ONE CIVIC SQUARE JESSICA KRUSE
s CHECK AMOUNT: $11.70
CARMEL, INDIANA 46032 840 BENNETT COURT
o CARMEL IN 46032 CHECK NUMBER: 168567
CHECK DATE: 2/4/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUM AMOUNT DESCRIPTION
1160 4343004 11.70 TRAVEL PER DIEMS
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM�
G.�M
TO
2.
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER
DATE FROM TO READING AUTO MILEAGE
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED x
PER MILE
PCO t ;2
AUTO LICENSE NO. TOTALSO 1 0
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. t
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, of er allowing all just credits
and that no part of the same has been paid.
ate
i
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form.
That it is duly authenticated as required
by law
That it is based upon statutory authority.
That it is apparently correct
incorrect
Disbursing Officer
On Account of Appropriation No. for
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J-j 1 bate Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
CITY OF CARMEL
2/2/09
An invoice or 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
Jessie Kruse Purchase Order No.
1231 S. Adams St., Apt 15 Terms
Bloomington, IN 47403 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1/29/09 Milea e Log Mileage reimbursement for City of Carmel duties $11.70
Total 11.70
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.
2/2/09
ALLOWED 20
Jessie Kruse IN SUM OF
1�
1231 S. Adams St: 15
Bloomington IN 47403
11.70
ON ACCOUNT OF APPROPRIATION FOR
1160 Mayor 4343004
T rav el per Die
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
Milea eLo 4343004 $11.70 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
20
v Signa
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund