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HomeMy WebLinkAbout172918 05/27/2009 CITY OF CARMEL, INDIANA VENDOR: 362020 Page 1 of 1
ONE CIVIC SQUARE DAWN LINGELBAUGH CHECK AMOUNT: $15.95
?o CARMEL, INDIANA 46032 1089 HALFMOON LANE
M o CICERO IN 46034 CHECK NUMBER: 172918
CHECK DATE: 5/27/2009
DEPARTMENT ACCOUNT PO N UMBE R IN VOICE NUMBER A MOUNT DESCRIPTION
1201 ^r 4343002 15.95 EXTERNAL TRAINING TRA
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
TO
(GOVERNMENTAL UN
7q��Vy) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTMJTI
SPEEDOMETER AUTO MILEAGE
DATE p FROM TO READING NATURE OF BUSINESS TRAVELED 0
49 POINT POINT START FINISH PER MILE
Th LL_ e -5 mac r
D
p C14 L 2
AUTO LICENSE NO. TOTALS OL 5S
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 accqunt is just and correct, that the amount claimed is legally due, after allowing all just credits
and that no part o f the same has been paid.
Date
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
l �y) by law
4,3 That it is based upon statutory authority.
That it is apparently correct
incorrect
l
Disbursing Officer
On Account of Appropriation No. for
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(Board or Commission) 0
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(Official Title)
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A.E. BOYCE CO., INC. "CIE, IN 01136
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Prescribed State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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
Shelly Lingelbaugh Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total $15.95
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. 05 2 RANT NO.
ALLOWED 20
IN SUM OF
$15.95
ON ACCOUN �A? RIATION FOR
FUND
1201 Human Resources
Board Members
D INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
1201 bill(s) is (are) true and correct and that the
15.95 materials or services itemized thereon for
which charge is made were ordered and
received except
20
f
Si ture
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund