HomeMy WebLinkAbout170104 03/18/2009 CITY OF CARMEL, INDIANA VENDOR: 358684 Page 1 of 1
0 ONE CIVIC SQUARE SHANNON SHERMAN
CARMEL, INDIANA 46032 18816 WIMBLEV WAY
CHECK AMOUNT: $174.94
NOBLESVILLE IN 46060 CHECK NUMBER: 170104
CHECK DATE: 3/18/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343004 174.94 TRAVEL PER DIEMS
I
PRPSCRIBCD BT STATE BOARD OF ACCOUNTS
GEeFAALFORM 110. fM (1965)
MILEAGE CLAIM
T O
�rrlom�
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD. DEPARTIINT OR iNS17=108)
FROM To SPEEDOM AUTO MILEAGE
DAT READING
J NATURE OF BUSINESS POINT POINT START FINISH TRA 66
PER MI
f
T
I''
tr
b 7 I
x7 7 8 g 9
ell 9
no
G9
l
AUTO LICENSE NO. TOTALS 1 /y
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed ileage or official highvray map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing ac�gT}nt�d c �at2l� amavT}# is legally due t8�aliowinq all just c its
and that no part of the same has been paid, Laos N 1 l 11 1 QD
Date
p o.*
FEB 2 7 2009
BY.
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
358684 Sherman, Shannon Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/27109 Reimb. Mileage 12/11/08 2126/09 174.94
Total 174.94
I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.$
20_
Clerk- Treasurer
Voucher No. Warrant No.
358684 Sherman, Shannon Allowed 20
In Sum of
174.94
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 174.94 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
12 -Mar 2009
Signature
174.94 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund