HomeMy WebLinkAbout209778 06/18/2012 CITY OF CARMEL, INDIANA VENDOR: 365463 Page 1 of 1
ONE CIVIC SQUARE MATTHEW GREGORY
CARMEL, INDIANA 46032 C/O ESE CHECK AMOUNT: $121.50
CHECK NUMBER: 209778
CHECK DATE: 611812012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 121.50 TRAVEL FEES EXPENSE
PRPSCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORL Ilc. 101 1I986)
MILEAGE CLAIM /v` q Gye d J- i J
TO
tOOVEAIUIENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF,ICE, BOARD. DEPARTWENT OR INS =1oN)
SPEEDOMEZNTSH AUTO
F E SS
FROM TO I READING MILES CQ
Z D
Q NAT[IRE OF BUSINESS
POINT POINT START ]'RAVELED PER TILE
9; i 'k P
P
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 due, after aliowing all just credits
end that no part
c) of the same has been paid.
Date 5 1. 2 q
RECEIVE
MAY so 2012
PRPSCRI6CD BY STATE BOARD OF ACCOUNTS
GENERAL FORM IIO. IQI (1966)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF. BOARD, DEPARTMENT OR INSTTTUTION)
SPEEDOMETER AUTO MILE E
D�TE FROM TO READING .f NATURE OF BUSINESS MILES a t �i
2a POINT POINT START FINISH TRAVELED PER MILE
V
3
D 9" tom► .n+A►+- a 6 3`
d
0.
r
T
s 0
V
7. 3 a
lot- 7, J
PT vt. I
0 q 10
v>7 O
pT
AUTO LICENSE NO. A v 105' 3 0 V
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 allow' g all just credit
and that no part of the same has been paid.
Date [-Z
0� -E
r
MAY 3 0 2012
a
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.
365463 Gregory, Matthew Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
5/25/12 Reimb Mileage 4/16 5/24/12
121.50
Total 121.50
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.
365463 Gregory, Matthew Allowed 20
i
In Sum of
121.50
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -7 Reimb 4343000 121.50 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
14 -Jun 2012
Signature
121.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund