HomeMy WebLinkAbout215404 12/11/2012 CITY OF CARMEL, INDIANA VENDOR: 364657 Page 1 of 1
ONE CIVIC SQUARE JESSICA RICHARDS CHECK AMOUNT: $114.17
CARMEL, INDIANA 46032 1832 N GLENDORA DR
+,« INDPLS IN 46214 CHECK NUMBER: 215404
CHECK DATE: 12/11/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 114 . 17 TRAVEL FEES & EXPENSE
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PRBSCRIBCD HY STATE BOARD OF ACCOUNTS
GENERAL FORM Np.IBl 11985)
MILEAGE,CL I7ACCOUT T
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DATE FROM TO READI ! AUTO MILE E
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+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determini d by fix d ileage or official highway
Pursuant to the provisions and penalties of Chapter 155,Acts 1953,I hereby certify that the foregoing acc unt is ju a d correct, that the aT ..ni imed is egally due,aft allow- g all)u t credits
and that no artt�oi he same has been paid.
Date 12-
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BY: DEC 4 2012
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BY:
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PRESCRIBED HY STATE BOARD OF ACCOUH15 ! GENERAL FORM I40.101(INS)
MILEAGE CL I j cot, ! ,.Jn
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(GOVERNMENTAL UNI11
ACCOU T F APPROPRIATION NO. FOR
(OFi1CP,HOAp➢.DEPARTMENT OR INSrIMiON)
DATE FROM - TO --- SREADII PEEDO�IET++ •MILES Cd 55'� c AUTO MILEAGE
NATURE OF BUSINESS
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+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determin d by fix d 1 lileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155,Acts 1953,I hereby certify that the foregoing ace unt is ju a d correct,that the amount claim is gaily due,a r all wing 11 " t redits
end that no art of t e�same has been paid.
Date !�
QEC 42012
BY:
PRFSCRIBED BY STATE BOARD OF ACCOUNTS MILEAGE CLAIM /\ , 11 ,� ^ GENERAL FORM NO.101(19BE)
TO v `LG"///�' -az"
(GOVERNMENTAL UNrrt
ON ACCO T OF APPROPRIATION NO. FOR
(OFFICE,BOARD,DEPARTMENT OR INSTTMION)
FROM TO SPEEDOMETER AUTO A(Ii,E
DATE I READING jAC
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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 gal due,after allow' q all jus credits
end that no part of he same has been paid.
Date
DEC 4 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.
364657 Richards, Jessica Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
11/28/12 Reimb Mileage 8/7 - 11/27/12 $ 114.17
Total $ 114.17
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.
364657 Richards, Jessica Allowed 20
In Sum of$
$ 114.17
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-4 Reimb 4343000 $ 114.17 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
6-Dec 2012
Signature
$ 114.17 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund