HomeMy WebLinkAbout210559 07/05/2012 CITY OF CARMEL, INDIANA VENDOR: 363382 Page 1 of 1
ONE CIVIC SQUARE MEAGAN STORMS
CHECK AMOUNT: $116.77
CARMEL, INDIANA 46032
r —sa' CHECK NUMBER: 210559
CHECK DATE: 7/5/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 116.77 TRAVEL FEES EXPENSE
PRESCRIBED HT STATE BOARD Or ACCOUNTS
cENCRAL FORM No. IBl (INS)
Cc eQ MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF7CE, BOARD. DFlAATM7,l(T OA INSTTTUT108t
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING MILES C4'
ZO NATURE OF BUSINESS
POINT POINT START FINISH TRAVELED PER MILE
r- A 3 3
i) 616
L i I
a
{•/1 G
V}I,n -�l 2 2
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. tt
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
and that no part of the same has been paid.
Date n
I T".�7
JUN 1
S �C(Y)s
PRG.SCRIR[D HT STATE BOARD OF ACCOUNTS
GENERAL FORy NC. 101 (1%6)
f`J MILEAGE CLAIM
To
1�1 ON ACCOUNT OF APPROPRIATION NO. FOR
�V n
(OHICE, BOARD, DERARTMWT OR INSTnUrION)
SPEEDOMETER
DATE FROM TO READING AUTO EA.GE 11
POINT POINT START FINISH NATURE. OF BUSINESS TRAVELED �S C
EA MILE
M n 3 LA TO
S 7. 3 cV
rylcul Irl I Y
lit M P
l v (+1 S C cgs
i} 6
f Q 2 Z
1
m
Lill
E o YWW cr%gw .�r
1 r
I. I
S
rm 3
L f IY U i 5C 3 5�
nA
ct
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. a
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, 1 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 of the same has been paid.
Date
RECM
V7
JUN 12 2012
BY
C
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.
363382 Storms, Meagan Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
5/30/12 Reimb Mileage 5/1 5/30/12 116.77
Total 116.77
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.
363382 Storms, Meagan Allowed 20
In Sum of
116.77
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/rITLE AMOUNT Board Members
Dept
1081 -7 Reimb 4343000 116.77 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
mo
Signature
116.77 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund