HomeMy WebLinkAbout211318 07/31/2012 CITY OF CARMEL, INDIANA VENDOR: 360926 Page 1 of 1
0 ` ONE CIVIC SQUARE SHAVONNE HOLTON
CARMEL, INDIANA 46032 3707 N MERIDIAN ST APT 3B CHECK AMOUNT: $88.25
4.roN a� INDIANAPOLIS IN 46208 CHECK NUMBER: 211318
CHECK DATE: 7/31/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343000 REIMB 88 . 25 TRAVEL FEES & EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 110.101(IN6)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNITt
ON ACCOUNT OF APPROPRIATION NO. FOR
(OHICE,BOARD,DEPART14ENT OR INSTITUTION)
SPEEDOMETER
DATE FROM TO I READING + AUTO
2a POINT POINT START FINISH NATURE OF BUSINESS TRAVELED MILES 6� c
_ PER MILE
--- Q I i
br C (� r r
NV V
t
_ 1 S
t I
MCC f � I
7 CAA
C C-
rC 1 n
rnCIC (row
c}
AUTO LICENSE NO, TOTALS Q , ^�
+ SPEEDOMETEB READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway.map. 1 VIAL 88,25 •J
Pursuant to the provisions and penalties of Chapter 155,Acts 1953,I hereby certify that the foregoing account is just and rrect,that the amount claimed is legally d ,a ter allowing part of the same has been paid. inq all just credits
end that no. —7
/�
Date �� ' / /� +
RECE-
JULi 10 2912 Ulf ZOX -f)"S
- _-_ - - Cnv-ee nc cks-0 e N
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 110.101 119Eti)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNrn
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD,DEPARTMENT OB INSTITUTION)
SPEEDOMETER
ZO�"'A,r FROM TO READING + NATURE OF BUSINESS MILES d S,tj ID
1 y� POINT POINT START FINISH TRAVELED PER MILE
i
f i ---
e
i -
AUTO LICENSE NO.
TOTALS
2�A 13
+ 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 claim t a due,a 11 l 3 ving all just credits
end that no art o-the same has been paid.
Date
7R R CF7,VED ��v (3n n \`�Gr)
JUL 10 2012 Hog SA-
pv.
c nee o c.GsAA ,e/, H (0 13S"
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
7/6/12 Reimb. Mileage 5/25 - 7/6/12 $ 88.25
Total $ 88.25
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 Aliowed 20
8001 Canary Ln Apt A
Indianapolis, IN 46260
In Sum of$
$ 88.25
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1082-6 Reimb. 4343000 $ 88.25 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
26-Jul 2012
Signature
$ 88.25 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund