HomeMy WebLinkAbout217159 02/13/2013 CITY OF CARMEL, INDIANA VENDOR: 365463 Page 1 of 1
ONE CIVIC SQUARE MATTHEW GREGORY
� CARMEL, INDIANA 46032 C/0 ESE CHECK AMOUNT: $101.88
CHECK NUMBER: 217159
CHECK DATE: 2/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 101 . 88 TRAVEL FEES & EXPENSE
PRESCRIBED BY STATE BOARD Or ACCOUNTS GENERAL FORM 110.101 EMS)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNITI
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF,-ICE,BOARD.DUKATM(E?a OR INSTITUTION)
SPEEDOMETER Fg�
DATE FROM TO I READING + NATURE OF BUSINESS AUTO
ILES (� S"S�S'C
Z�j ' POINT POINT START F1NiSH TRAVELED PER MILE
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AUTO LICENSE NO. TOTALS V
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. 1 Oa.GP
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 aliowing all just credits
end that no pafrs of the sa a has been paid. �.
Date / — /
JAN 21 2013
7b-y
f
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show-, kind of serfice its, price per performed,dates service rendered, by
whom rate
, rates per day, number of hours, r
Payee Purchase Order No.
Terms
365463 Gregory, Matthew
Invoice Invoice Description PO# Amount
Date Number (or note attached invoice(s)or bill(s)) 101.88
1/18/13 Reimb Mileage 11128112 - 1/18/13
Total $ 101.88
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.
365463 Gregory, Matthew Allowed 20
In Sum of$
$ 101.88
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#[TITLE AMOUNT Board Members
Dept#
1081-7 Reimb 4343000 $ 101.88 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
7-Feb 2013
Signature
$ 101.88 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund