HomeMy WebLinkAbout215264 12/10/2012 CITY OF CARMEL, INDIANA VENDOR: 065950 Page 1 of 1
ONE CIVIC SQUARE DIANA CORDRAY CHECK AMOUNT: $162.00
CARMEL, INDIANA 46032 11843 STONEY BAY CIRCLE
•. _o� CARMEL IN 46033-9501 CHECK NUMBER: 215264
CHECK DATE: 12/10/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4343004 156 . 50 MILEAGE
1701 4343004 5 . 50 PARKING
AFFIDAVIT FOR EXPENSES
I,Diana L. Cordray, incurred expenses while traveling to IACT meetings in
Indianapolis, IN. Those expenses on November 19, 2012 ($1.50) and December 5,
2012 ($4.00) were for parking for a total of$5.50.
Diana L. Cordray
Clerk Treasurer
December 10, 2012
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995)
CITY OF CARMEL
An invoice or 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.
0 Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
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.
1 ALLOWED 20
6
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I 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
20
.AL44KAuU&-LO W47
Signat
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts General Form No.101 (1955)
MILEAGE CLAIM
TO DR.
�j -- (Governmental Unit)
yed- On Account of Appropriation No. for
(Office, Board, Department or Institution)
DATE FROM TO ODOMETER READING' NATURE OF BUSINESS AUTO MILES MILEAGE @ , .5S-5
20 Point Point Start Finish TRAVELED PER MILE
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 clai d is legally due, after
allowing all just credits, and that no part of the same has been paid.
Date /6'e' /'q ��
Claim No. Warrant No. I have examined the within claim and
hereby certify as follows:
IN F VOR OF
That it is in proper form;
I
That it is duly authenticated as required
by law;
That it is based upon statutory authority;
That it is apparently correct
$ incorrect
On Account of A P5A)-,M opriation No. 1 for
Disbursing Officer
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in the sum of $ o
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