HomeMy WebLinkAbout210401 07/05/2012 CITY OF CARMEL, INDIANA VENDOR: 360926 Page 1 of 1
0 ONE CIVIC SQUARE SHAVONNE HOLTON CHECK AMOUNT: $77.15
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ti�� CARMEL, INDIANA 46032 3707 N MERIDIAN ST APT 3B
INDIANAPOLIS IN 46208 CHECK NUMBER: 210401
CHECK DATE: 7/5/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 77.15 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS G FORM NO. 101 (1988)
MILEAGE CLAIM
TO
(GOVERNMENTAL UIUT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPAATIMT OR TNSTITUT ON)
FROM TO SPEEDOMETER AUTO MILEAGE
READING
1lr POINT POINT STAIN FINISH NATURE OF BUSINESS TRAY ED 1
PER MILE
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AUTO LICENSE NO. TOTALS a i
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. 1
Pursuant to the provisions and penalties of Chapter 155, Acts 1853, I hereby certify that the foregoing account is just and correct, that the amount claimed is legal us, r owing all lust credits
end that no art of the same has been paid.
Date -z--
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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.
360926 Holton, Shavonne Terms
8001 Canary Ln Apt A Date Due
Indianapolis, IN 46260
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
6/17/12 Reimb. Mileage 4/1 5/24/12 77.15
Total F 77.15
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
i
Voucher No. Warrant No.
360926 Holton, Shavonne Allowed 20
8001 Canary Ln Apt A
Indianapolis, IN 46260
In Sum of
77.15
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #!TITLE AMOUNT Board Members
Dept
1081 -1 Reimb. 4343000 77.15 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
77.15 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund