HomeMy WebLinkAbout179332 11/11/2009 CITY OF CARMEL, INDIANA VENDOR: 361086 Page 1 of 1
ONE CIVIC SQUARE JACOB C MOORE
CARMEL, INDIANA 46032 1790 FRANKLIN BLVD CHECK AMOUNT: $38.61
CARMEL IN 46032 CHECK NUMBER: 179332
CHECK DATE: 11/11/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT D
1046 4343004 38.61 TRAVEL PER DIEMS
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
To J ac ,�Cfr✓�.
(GOVERNMENTAL UNI'n
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPAATMFNT OR INSTITUTION)
SPEEDOMETER
2 �T FROM TO READING AUTO TIT;,�g
NATURE OF BUSINESS MILES �ry rj "j
POINT POINT START FINISH TRAVELED PER MILE
23
-Z
-25
�Z
a
�i
i3
by 1
Q
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 due/aer li owing all just credits
and that no part of the same has been paid.
Date `y
0C T 2 r .�`tt1 000
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.
361086 Moore, Jacob Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
10/26/09 Reimb. Mileage 9/17 10/26/09 38.61
Total 38.61
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.
361086 Moore, Jacob Allowed 20
In Sum of
38.61
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 38.61 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
5 -Nov 2009
Signature
38.61 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund