HomeMy WebLinkAbout216723 01/29/2013 ,a- CITY OF CARMEL, INDIANA VENDOR: 366239 Page 1 of 1
ONE CIVIC SQUARE MONICA HADDOCK
i tti CHECK AMOUNT: $109.89
o CARMEL, INDIANA 46032 C/O ESE
CHECK NUMBER: 216723
CHECK DATE: 1/29/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 109 . 89 TRAVEL FEES & EXPENSE
PRrSCRIHED BY STATE HOARD OF ACCOUNTS GENERAL FORM NG.101(1986)
MILEAGE CLAIM
C
(GOVERNMENTAL IT) ON ACCOUNT OF APPROPRIATION NO. FOR
It.
(OFiICE,HOARD.DEPAATME]R OR INSTRVIlON)
SPEEDOMETER
DATE FROM TO READING +
2•� 'n MMFkGE
AUTO
POINT START FINIS NATURE OF BUSINESB TA LE D � c
POINT
PER MILE
C
I LO
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tT
iy� c
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mc
Cl-�----o� --o C' O 5.5rj
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. l x,89
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 allowing all just credits.'
and that o part of the same has been paid.
Date JAN 1 1 2013
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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
12/21/12 Reimb Mileage 11/13 - 12/21/12 $ 109.89
Total $ 109.89
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
Voucher No. Warrant No.
366239 Haddock, Monica Allowed 20
In Sum of$
$ 109.89
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-2 Reimb 4343000 $ 109.89 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
24-Jan 2013
li, 11
Signature
$ 109.89 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund