HomeMy WebLinkAbout207538 03/26/2012 CITY OF CARMEL, INDIANA VENDOR: 366102 Page 1 of 1
ONE CIVIC SQUARE LEONID MELNIKOV CHECK AMOUNT: $22.76
CARMEL, INDIANA 46032 C/O ESE
CHECK NUMBER: 207538
CHECK DATE: 3126/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 22.76 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
Le on 4 MILEAGE ,CLAIM
Loner, �N1P.�n�bfa✓
TO
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD. DEPARTMENT OR INSTITUTION) 1
DATE
FROM TO SPEEDOMETER I i AUTO MILEAGE
R EADIN G NATURE OF BUSINESS MILES 5 Q
19 POINT POINT START FINISH TRAVELED
PER MILE
L4 L i
2 !S I wC in tA p e('f l eaurr
i
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 foregoing�account is just and correct, that the amount claimed is legally ue, after Ing st credits
and thatt no part of the same has been paid.
Date h I 1 3 43 0 I
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.
Melnikov, Leonid Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
2/28/12 Reimb Mileage 12/13/11 2/15/12 22.76
Total 22.76
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. Warrant No.
Melnikov, Leonid Allowed 20
In Sum of
22.76
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -10 Reimb 4343000 22.76 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
22 -Mar 2012
Signature
22.76 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund