HomeMy WebLinkAbout207765 04/10/2012 CITY OF CARMEL, INDIANA VENDOR: 360144 Page 1 of 1
ONE CIVIC SQUARE CYNTHIA CANADA
CHECK AMOUNT: $77.14
CARMEL, INDIANA 46032 11508 LUCKY DAN DRIVE
NOBLESVILLE IN 46060
CHECK NUMBER: 207765
CHECK DATE: 4/10/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMS 77.14 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORK 110. 101 (1986)
MILEAGE CLAIM 1
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
i
tOFi7CE, BOARD, DEPARTMMU OR 1NSTMMON)
SPEEDOMETER AUTO MILEAGE
DATE FROM To READING i NATURE OF BUSINESS MILES (,y
Za POINT POINT START FINISH TRAVELED PER MILE
f
0 rvO
e ti
5
1r1� 0 (It Z) —i
"s 5 i
t
Q
AUTO LICENSE NO. TOTALS
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. I >A L -7-7
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed is le ally due, afteTaItowing' aII just cred its
end that part f the same has been paid.
Date V n C
Lis
MaR 2b R Z V 012 M ff),
By...................... d�—
YRPSCRIHLD BY STATE BOARD OF ACCOUNTS
GENERAL FOAM NO. 101 (14667
MILEAGE CLAIM
ro
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSnMiON)
FROM TO LSPEEDOMETER AUTO AGE
DATE I READING
20 NATURE OF BUSINESS Nms C$ So
POINT POINT START FINISH TRAVELED PER LE
L MILE
v L 4
3:
I
t
Q �X
D r'7
rn II D
1 L f
non i ryu 4
AUTO LICENSE NO. TOTALS Ll 9 v
6
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 allowing all just credits
end that o part the same has been paid.
Date p, c) i �q
�,q 3qso o q 0
I MAR 2 6 2012
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.
360144 Canada, Cyndi Terms
11508 Lucky Dan Dr
Noblesville, IN 46060
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
3/12/12 Reimb Mileage 1/3 3/12/12 77.14
Total 77.14
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 -1.6
20_
Clerk- Treasurer
Voucher No. Warrant No.
360144 Canada, Cyndi Allowed 20
11508 Lucky Dan Dr
Noblesville, IN 46060
In Sum of
77.14
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -5 Reimb 4343000 77.14 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 -Apr 2012
Signature
77.14 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund