HomeMy WebLinkAbout211114 07/18/2012 CITY OF CARMEL, INDIANA VENDOR: 065950 Page 1 of 1
ONE CIVIC SQUARE DIANA CORDRAY
CHECK AMOUNT: $206.18
CARMEL, INDIANA 46032 11843 STONEY BAY CIRCLE
CARMEL IN 46033-9501
CHECK NUMBER: 211114
CHECK DATE: 7/1812012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4343004 193 . 68 MILEAGE
1701 4343004 12 . 50 PARKING
Prescribed by Slate Board of Accounts City Form No.201(Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or 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.
P ee
l�L l� L L 04 A Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
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.
ALLOWED 20
IN SUM OF $
$ Q
ON ACCOUNT OF APPROPRIATION FOR
(!T- 4
�l
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I 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
U2
V
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts General Form No.101 (1955)
MILEAGE CLAIM
T I1 TO DR.
� e (Governmental Unit)
(Vlel-k ;1�&4112' On Account of Appropriation No. for
(Office,Board, Department or Institution)
DATE FROM TO ODOMETER READING` NATURE OF BUSINESS AUTO MILES MILEAGE
20�o`Z Point Point Start Finish TRAVELED PER MILE
S CEU-� le �3 n. - atp I I
92116 /J /r C►l 56, 3 '7 tdt.w4
S
3 �8'�9 --
k ISO
i t 1 a Uja 1&6
r I 73 l4- CL
a n —7& Gn
t cis F r � r :4 C 7
Auto License No. TOTALS / P
* 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, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after
allowing all just credits, and that no part of the same has been paid.
Date
�2/
Claire No. Warrant No. I have examined the within claim and
hereby certify as follows:
IN F VOR OF
lam That it is in proper form;
That it is duly authenticated as required
by law;
That it is based upon statutory authority;
CThat it is apparently correct
$
I incorrect
On Accoun f Appropriation No.
n� J ff Disbursing Officer
Q 10
Allowed 20 0 Q
_ o o ,
Cr
in the sum of$ o B-� a
(D 0�
(D En. rz�
( a m
9
(Board or Comission) a
m OO
((D (D
(D
FILED (D
R
O O
o
6 (D
(D u (D
co) (D
(D
(Official Title)
O _
0 �3' Q