HomeMy WebLinkAbout226164 11/18/2013 CITY OF CARMEL, INDIANA VENDOR: 367748 Page 1 of 1
` ONE CIVIC SQUARE ELIZABETH VANHOOSE
h 0
CARMEL, INDIANA 46032 C/0 ESE CHECK AMOUNT: $9.04
CHECK NUMBER: 226164
CHECK DATE: 11/18/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 9 . 04 TRAVEL FEES & EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 110.101(19BQ
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT)
fs ON ACCOUNT OF APPROPRIATION No- FOR
(OFFICE,BOARD,DEPARTM EMT OR 1WSr[TUT1ot41
...........
DATE FROM TO SPEEDOMETER
READING + AUTO @ MIL AGE
L5 NATURE OF BUSINESS MILES 0,5 r
POINT POINT START FINISH TRAVELED
PER MILE
Ntj U M
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 legally due,after allowing all just credits
and that no part of the same has been paid.
Date 1 0
O
PIN
NOV 4 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.
VanHoose, Elizabeth Terms
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
10/25/13 Reimb Mileage 10/22- 10/23/13 $ 9.04
Total $ 9.04
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.
VanHoose, Elizabeth Allowed 20
In Sum of$
$ 9.04
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or Board Members
Dept#
INVOICE NO. CCT#/TITL AMOUNT
1081-10 Reimb 4343000 $ 9.04 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
$ 9.04 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund