HomeMy WebLinkAbout213393 10/09/2012 CITY OF CARMEL, INDIANA VENDOR: 360144 Page 1 of 1
`•-' ONE CIVIC SQUARE CYNTHIA CANADA
'+ 2. CARMEL, INDIANA 46032 11508 LUCKY DAN DRIVE CHECK AMOUNT: $113.65
NOBLESVILLE IN 46060 CHECK NUMBER: 213393
CHECK DATE: 10/9/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 113 . 65 TRAVEL FEES & EXPENSE
PRPSCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 110.101 11986) F
MILEAGE CLAIM
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(GOVERNMENTAL UNIIJ
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFEIM BOARD,DEPAATO,xT OR 1NSTTTUTION)
SPEEDOMETER •"A M
DATE FROM TO READING + AUTO MILE r
2P- POINT POINT START FINISH NATURE OF BUSINESS TRAVELED _
PER MILE
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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. 13,�5 '7>✓k��
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.
end Ihain�part 11 the has been paid. '
Date Gy1i OQIL`
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PAISCRIBED BY STATr BOARD OF ACCOURn GENERU FORM 110.101 tl"6)
MILEAGE CLAIM ��j Y-1� ` ncdC
To
(GOVERNMENTAL UN111
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFiTCE•BOARD.DEPARTMENT OR INSrMTrION)
SPEEDOMETER
DATE FROM TO READING + AUTO t1ILE E
NATURE OF BUSINESS MILES a .555 C
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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.
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
end thrt of the same has been paid.
Date Ti f 1 9
SEP 2 0 2012
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 110.101 11986)
MILEAGE CLAIM
(GOVERNMENTAL UNln �M
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF71CF.,BOARD,DEPARTME](T OR INS rrUTION)
DATE FROM TO SREAD NG +R AUTO M�,Ljt�E
- POINT POINT START FINISH NATURE OF BUSINESS TRAVELED ED S�>
PER MILE
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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.
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 n part o the same has been paid.
1^ Q
Date � � ' v'
rs
F7-
SHP0 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.
360144 Canada, Cyndi Terms
11508 Lucky Dan Dr
Noblesville, IN 46060
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
9/19/12 Reimb Mileage 7/10 -9/19/12 $ 113.65
Total $ 113.65
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.
360144 Canada, Cyndi Allowed 20
11508 Lucky Dan Dr
Noblesville, IN 46060
In Sum of$
$ 113.65
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-5 Reimb 4343000 $ 113.65 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
4-Oct 2012
r�
Signature
$ 113.65 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund