HomeMy WebLinkAbout215036 12/04/2012 CITY OF CARMEL, INDIANA VENDOR: 366239 Page 1 of 1
ONE CIVIC SQUARE MONICA HADDOCK CHECK AMOUNT: $116.12
o CARMEL, INDIANA 46032 C/O ESE
CHECK NUMBER: 215036
CHECK DATE: 12/4/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 116 . 12 TRAVEL FEES & EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 140-101(1906)
MILEAGE CLAIM
TO Mnn"C0' 4n1ddr\(A(- .
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO.- FOR
(C1171CT,B.A111).DEPARTMENT OR INSTITUTION)
SPEEDOMETER AUTO 11 WLEAir.E
DATE FROM TO READING NATURE OF BUSINESS MILES
POINT START FINISH TRAVELED
POINT PER MILE
C7 MCC_
-7
-"7
C
MCC
CY
'10 1`7 1-7
L:c 4 C C —1 a FpLt MC (n(n
rh K 9
OCF
1A
-AL
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 is just and correct, that the amount claimed is legally due,after allowing all just credits
end that no part of the same has been paid
Date
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V 15 201
NOV 15 201
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.
366239 Haddock, Monica Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
11/6112 Reimb Mileage 9/17 - 11/9/12 $ 116.12
,Total $ 116.12
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.
366239 Haddock, Monica Allowed 20
In Sum of$
$ 116.12
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-2 Reimb 4343000 $ 116.12 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
Y(Itkamow
Signature
$ 116.12 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund