HomeMy WebLinkAbout217719 02/26/2013 CITY OF CARMEL, INDIANA VENDOR: 366990 Page 1 of 1
ONE CIVIC SQUARE JOSH LANE CHECK AMOUNT: $17.99
CARMEL, INDIANA 46032 C/O ESE
CHECK NUMBER: 217719
CHECK DATE: 2/2612013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 17 . 99 TRAVEL FEES & EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO 101(1986)
MILEAGE CLAIM
TO
7G-ERNMENTALUNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
C.1 rw7
(OFFICE.BOARD,VEFARTKENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
` READING + NATURE OF BUSINESS MILES (� ,$(p- a
2P V5 POINT POINT START FINISH TRAVELED PER MILE
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10 G u � ✓�iih 3- 5
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AUTO LICENSE NO. TOTALS 1
+ 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 claimed is legall due,after allowing credits
and that no part of the same has been paid.
Date
FIVE
1 i
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.
Lane, Josh Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
1/29/13 Reimb Mileage 1/7 - 1/29/13 $ 17.99
Total $ 17.99
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.
Lane, Josh Allowed 20
In Sum of$
$ 17.99
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-11 Reimb 4343000 $ 17.99 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
21-Feb 2013
Signature
$ 17.99 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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