HomeMy WebLinkAbout215700 12/18/2012 CITY OF CARMEL, INDIANA VENDOR: 366785 Page 1 of 1
ONE CIVIC SQUARE BONNIE LEWIS CHECK AMOUNT: $18.32
CARMEL, INDIANA 46032 a0 COURT
CHECK NUMBER: 215700
CHECK DATE: 12/18/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1301 4343004 REIMB 18 . 32 TRAVEL PER DIEMS
Prescribed by State Board of Accounts General Form No.101 (1955)
MILEAGE CLAIM
� Lec r/� S TO 130)-J^11 DR.
(Governmental Unit)
On Account of Appropriation No. for
(Office, Board, Department or Institution)
DATE FROM TO ODOMETER READING' NATURE OF BUSINESS AUTO MILES MILEAGE @ e �ss
f o7 20� Point Point Start Finish TRAVELED PER MILE
LL— _ o �5 S SSE A i 'All G 3
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. i
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 credi , and that no part of the same has been paid.
Date rA `C 2� ajep:��k—��
Clam No. Warrant No. I have examined the within claim and
hereby certify as follows:
IN FAVOR OF
That it is in proper form;
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 Appropriation No. for
Disbursing Officer
O
Allowed 20 � ¢
" 0 •c
in the sum of$ o -
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(n 5- �
'0 (D
0 mCnB
(Board or Commission)
( ¢
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FILED o C
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(official Title)
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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.
P yee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
o�- 1--l-Lo ; --
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.
ALLOWED 20
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
30 ��• 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
Cost distribution ledger classification if Title/
claim paid motor vehicle highway fund