HomeMy WebLinkAbout178294 10/14/2009 CITY OF CARMEL, INDIANA VENDOR: 361086 Page 1 of 1
ONE CIVIC SQUARE JACOB C MOORE
I CHECK AMOUNT: $38.61
CARMEL, INDIANA 46032 1790 FRANKLIN BLVD
CARMEL IN 46032 CHECK NUMBER: 178294
CHECK DATE: 10/14/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT D
1046 4343004 38.61 TRAVEL PER DIEMS
/r
S EP 1 1000 Lu
r.......... GENERAL FORM 110. 101 (1986)
PRESCRIBED BY STATE BOARD OF ACCOUNTS
MILEAGE CLAIM SQ Co t AJ do re
TO
(GOVERNMENTAL UNITI ON ACCOUNT OF APPROPRIATION NO. FOR
(OF BOARD. DEPARTW3YT OR INSTFRFrION)
SPEEDOMETER AUTO VILE E
2aD� FROM TO I READING
NATURE OF BUSINESS MILES
POINT POINT START FINISH TRAVELED PEN MLE
r 0 c c. n os.-es
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2 1
3
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15
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, ,after �alliio�wing all just credits
end that.no rt of the same has been paid.
Date
CL
Ifl
F 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.
Moore, Jacob Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
9/16/09 Reimb. Mileage 8/11 9/16/09 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.
Moore, Jacob Allowed 20
I
In Sum of
t}
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
7 -Oct 2009
Signature
38.61 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund