HomeMy WebLinkAbout168172 01/21/2009 a CITY OF CARMEL, INDIANA VENDOR: 360204 Page 1 of 1
ONE CIVIC SQUARE SAMUEL RICHARDSON
CARMEL, INDIANA 46032 11109 ECHO CREST EAST DRIVE CHECK AMOUNT: $88.92
INDIANAPOLIS IN 46280 CHECK NUMBER: 168172
CHECK DATE: 1121/2009
DEPARTMENT ACCO PO N UMBER INVOI NUMBER A D ESCRIPTION
1046 4343000 88.92 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
r MILEAGE CLAIM LC/lG�l�O�o
S TO
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIA'T'ION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER
DATE FROM TO READING AUTO MILEAGE
-i9 2 PO POINT START FINISH NATURE OF BUSINESS TRAVELED 5g 5 Q
PER MILE
c Ile Woo.
12 Z
ey e
o,.. C o N C9oc a^
C
I ff 1
1 2
Z/ 71 1(r,0 Ce S
Z oo no r
1
i 2, 1 U OA to I t S W .4-
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 foregoi)ig account is just and correct, that the amount claimed is legally due, after allowing' all just credits r
,znd that no part of the same has been paid.
Dane
JAN 0 6 2009 c��.
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.
360204 Richardson, Sam Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/30/08 reimb. Mileage 12/1/08 12/30/08
88.92
Total 88.92
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
1 20
Clerk- Treasurer
i
Voucher No. Warrant No.
360204 Richardson, Sam Allowed 20
In Sum of
88.92
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 reimb. 4343000 88.92 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
6 -Jan 2009
Signature
88.92 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund