HomeMy WebLinkAbout211869 08/14/2012 CITY OF CARMEL, INDIANA VENDOR: 366458 Page 1 of 1
0 ONE CIVIC SQUARE JAMARR MOFFETT CHECK AMOUNT: $66.65
?° CARMEL, INDIANA 46032 C/O ESE
;rrori ° CHECK NUMBER: 211869
CHECK DATE: 8114/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343000 REIMB 66 . 65 TRAVEL FEES & EXPENSE
PRrSCRIBED By STATE BOARD Or ACCOUNTS GENERAL FORM 110.ICI IMP
C� ^ ?�, MILEAGE CLAIM��.�TC
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OT7CE,BOARD,DEFARTIRNT OR 1NSTRUr10N)
DATE FROM TO READING SPEEDOMETER AUTO MIj.E/�E
.+-
NATURE OF BUSINESS MILES (g��`'� �
Zo POINT POINT START FINISH TRAVELED PER
I Lk
K-
-I-, �LV
a
T 1 W
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. �C
1
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 claims is legally due,after allowing ju t redits,•
and that n art of the s9a a has been paid. `
Date — I � `Y�/� � 1 1
AUG 0 8 2012
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.
Moffett, Jamarr Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
8/3/12 Reimb Mileage 5/29-6/20/12 $ 66.65
Total $ 66.65
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.
Moffett, Jamarr Allowed 20
In Sum of$
$ 66.65
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1082-1 Reimb 4343000 $ 66.65 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
9-Aug 2012
Signature
$ 66.65 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund