HomeMy WebLinkAbout215039 12/04/2012 CITY OF CARMEL, INDIANA VENDOR: 358411 Page 1 of 1
ONE CIVIC SQUARE JENNIFER HAMMONS
CARMEL, INDIANA 46032 634 NORTHVIEW AVENUE CHECK AMOUNT: $259.74
INDIANAPOLIS IN 46220 CHECK NUMBER: 215039
CHECK DATE: 12/4/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 259 . 74 TRAVEL FEES & EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 140.101(1986)
MILEAGE CLAIM
TO—
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO.— FOR
tdHIEEBOARD,DEPARTMENT OR INST=108)
—r-----SPEEDOMETER
FROM To AU MILE&GE
DATE I I READING + NATURE OF BUSINESS MILES TO ss 's C
—tri, I POINT POINT START FINISH 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.
Pursuant to the provisions and penalties of Chapter 155,Acts 1953,1 hereby certify that the foregoing account i3 just and correct,that the amount claimed is le ally due,afitr aliowing
end that no part of t4e same has been paid.
Date 1-30/12
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NOV 15 2012
BY:
PRESCRIBED BY STATE BOARD OF ACCOUNTS I ) GENERAL FORM NO.101(1966)
MILEAGE CLAIM
70 y 1
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD,DEPARTMZNT OR INSTUVICION)
SPEEDOMETER AUTO Q AIU.EAG
�nDATE FROM TO READING �-
NATURE OF BUSINESS MILES
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TRAVELED PER��
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AUTO LICENSE NO. TOTALS (�( I l
+ 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 al,o ing just s
end that no pa of the same has been paid.
Date I���--
ET V E
NOV 15 2012
BY:
4 `
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.
358411 Hammons, Jennifer Terms
634 Northview Ave Date Due
Indianapolis, IN 46220
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
11/7/12 Reimb. Mileage 8/6 - 11/7/12 $ 259.74
Total $ 259.74
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.
358411 Hammons, Jennifer Allowed 20
634 Northview Ave
Indianapolis, IN 46220
In Sum of$
$ 259.74
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-10 Reimb. 4343000 $ 259.74 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
29-Nov 2012
Signature
$ 259.74 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund