HomeMy WebLinkAbout210372 07/05/2012 CITY OF CARMEL, INDIANA VENDOR: 365946 Page 1 of 1
ONE CIVIC SQUARE NANCY GOINS CHECK AMOUNT: $111.55
CARMEL, INDIANA 46032 C/O ESE
CHECK NUMBER: 210372
CHECK DATE: 7/5/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 111.55 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 110. 101 (1986)
MILEAGE CLAIM d anuL /,[/�J.} 1 S�
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF,ICE, BOARD, DEPAAn4X7 OR IN$'rRUriON)
SPEEDOMETER
DATE FROM TO READING AUTO MILEAGE
24 POINT POINT START FINISH NATURE OF BUSIN S 1 TRAVELED
PER MILE
L
Iv
�Z
(L
Z i
z 3
,S 2L
It
I o
L
rip
SI +lt d
AUTO LICENSE NO. TOTALS
2- 5 (MCP
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 clai ed is le ally due, aft allow" g all ju1t credits
and that n f the same has been paid.
Dale _(_.K_l Ic^t
RE E V F 7 --gyp
JUN 19 2012
BY:
6'
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORM NC- 101 1196
MILEAGE CLAIM �d
P R TO
Ary�t� t�
f oG 32, ON ACCOUNT OF APPROPRIATION NO. FOR
j W
O F, ICE. BOARD. DER OR )NSnM10N)
2 D �T F FROM TO I HEAD N AUTO MILEAGE
EAGE
1 PONT POINT START FINISH NATURE OF BUSINESS TRAVELED 6 C
PEA MILE
1— Inj
12 h
3 2
3 it 1 P t
f 0 C
�fy
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 cla' ed is leg lly w' all just +credits
end that no art o the same has been paid.
Date 7'
C tL: i 3Jj V
�0
JUN 1 9 2012
�I
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.
365946 Goins, Nancy Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
6/11/12 Reimb Mileage 3/27 6/8/12 111.55
Total 111.55
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.
365946 Goins, Nancy Allowed 20
In Sum of
111.55
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -1 Reimb 4343000 111.55 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
28 -Jun 2012
Signature
111.55 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund