HomeMy WebLinkAbout226072 11/18/2013 CITY OF CARMEL, INDIANA VENDOR: 367740 Page 1 of 1
0 ONE CIVIC SQUARE MARIE BURGE CHECK AMOUNT: $13.56
CARMEL, INDIANA 46032 C/O ESE
CHECK NUMBER: 226072
CHECK DATE: 11/18/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 13 . 56 TRAVEL FEES & EXPENSE
0
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORM 140.101(1986)
MILEAGE CLAIM
pp, TO e-��r
, SC. (GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO.- FOR
(OFITCE,BOARD,DEPARTMENT OR INSTITUTION)
DA TO READING A TO (AGE
.JE FROM SPEEDOMETER
2�0 ►:5 -
AUTO POINT START FINISH NATURE OF BUSINESS TRAVELED MILES ,tE
POINT D
44= I - I - PER MILE
We 5r Ci menon ►60110 1 f7
..................
_T 5Z
............
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 1953,1 hereby certify that the foregoing account is just and correct,that the amount claimed is le due,a raliowing all just credits,-
end that no part has been paid.
Date
lt;4
�1NOV 2013
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.
Burge, Marie Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
10/25/13 Reimb Mileage 9/24 - 10/23/13 $ 13.56
Total $ 13.56
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.
Burge, Marie Allowed 20
i
In Sum of$
I
$ 13.56
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-10 Reimb 4343000 $ 13.56 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
14-Nov 2013
Signature
$ 13.56 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund