HomeMy WebLinkAbout173478 06/10/2009 CITY OF CARMEL, INDIANA VENDOR: 356305 Page 1 of 1
ONE CIVIC SQUARE DARRELL D NORRIS CHECK AMOUNT: $168.30
CARMEL, INDIANA 46032 101 2ND AVE SW, #2C
CARMEL IN 46032
CHECK NUMBER: 173478
CHECK DATE: 6/10/2009
DEPARTME AC PO NUMBER INVOICE NUMBE AMOUNT DESCRIPTION
902 4239099 51909 168.30 OTHER MISCELLANOUS
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PRESCRIBED BY STATE BOARD OF ACCOUNTS 1,2C GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
•C OFF ICE, f BOARD, DEPARTMENT OR INSTITUTION)
�I BATE FROM TO SPEEDOMETER READING AUTO MILEAGE
MILES I POINT POINT START FINISH NATURE OF BUSINESS TRAVELED eti
PEA MILE
ii l o c avt�
LIM
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AUTO LICENSE NO. TOTALS �Q 30
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, after allowing all just credits
and that no part of the same has been paid.
Date
I
Claim No. Warrant No. I have examined the within claim and hereby
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IN FAVOR OF certify as follows:
That it is in proper form.
That it is duly authenticated as required
01 by law
That it is based upon statutory authority
f
That it is apparently Sl correct
incorrect
Disbursing Officer
On Account of Appropriation No. for
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A.E. EOYCE CO., INC. MUNCIE, IN 01136
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Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
CITY OF CARMEL
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
a (s -e Nor(; 5 Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
9yz/ ��3 90 9�
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
q23909 jbg,J 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 �9
Signature
Director of Operations
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund