HomeMy WebLinkAbout177904 09/29/2009 CITY OF CARMEL, INDIANA VENDOR: 363392 Page 1 of 1
ONE CIVIC SQUARE JAMES WHITELEY
i 0 CHECK AMOUNT: $16.50
CARMEL, INDIANA 46032
CHECK NUMBER: 177904
CHECK DATE: 9129/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESC RIPTION
1046 4343004 16.50 TRAVEL PER DIEMS
t,
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
TO V I (�a
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTMMON)
AT SPEEDOMETER.
READIN G AUTO MILEAGE
DATE TO
0 POINT POINT START FINISH NATURE OF BUSINESS TRAVELED C Q
PER MILE
Moira tA a .a, I 5
q. 3 gl 3 3 3.
Mc k�8 2
g D IS o� Z-
l z
NJ
g 20 $l 42 2
V77 b, Mc 81 StlSSS z
g 24 G C IFLGco YI5`tz y ti
15 MC (sod 8't6lO 2
r-C '�qr GL E(e-_- alol'A c.'.% e r `6163.3 5 P S 2
S fiz. 633 3 s Z
1 rt 6 3 2
.y /wQl.w• r S Z
r
AUTO LICENSE NO. TOTALS
SPEEDOMETER READING columns are to be used only distance between- points cannot be determined by fixed mileage or official highway map. /ZZ)
Pursuant to:the provisions and penalties of Chapter 155, Acts 19'33, I hereby certify that the foregoing ac oun is just and orrect, that the amount claimed is legally due aft owing all just credits
-end that no part of th same has been paid. Off SOo
Date
r 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.
Whiteley, ,James Terms
.J
Invoice Invoice Description
Date Number {or note attached invoice(s) or bill(s)) PO Amount
8/31109 Reimb. Milea a 8112 8128109
16.50
Total 16.50
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.
Whiteley, James Allowed 20
In Sum of
16.50
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 16.50 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
24 -Sep 2009
i
Signature
16.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund