HomeMy WebLinkAbout228552 1/28/2014 °,�,F CITY OF CARMEL, INDIANA VENDOR: 358411 Page 1 of 1
`' ONE CIVIC SQUARE JENNIFER HAMMONS
CARMEL, INDIANA 46032 634 NORTHVIEWAVENUE CHECK AMOUNT: $114.98
9 '�? INDIANAPOLIS IN 46220 CHECK NUMBER: 228552
CHECK DATE: 1/28/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 114 . 98 TRAVEL FEES & EXPENSE
JAN 19 2014
i_-_\ -- - ----- GENERAL FORM Ito.101(1986)
PRESCRIBED BY STATE BOARD OF ACCOUNT6
MILEAGE CLAIM
CC
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1C30�fFRNUENTAL UNI[7
C`� ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD,DEPARTMENT OR INSTITUTION)
DAT FROM TO 4 SPEEDOMETER AUTO AG
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POINT POINT START READING FINISH NATURE OF BUSINESS g'RMIL ED @ �
PER MILE
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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,I hereby certify that the foregoing account is just and correct,that the amount claimed is legally due,after allowin all jus redits
end that no part of the sa a has been paid.
Date ` 1
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.
358411 Hammons, Jennifer Terms
634 Northview Ave Date Due
Indianapolis, IN 46220
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
1/3/14 Reimb. Mileage 11/11 - 12/27/13 $ 114.98
Total $ 114.98
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
i
Voucher No. Warrant No.
358411 Hammons, Jennifer Allowed 20
634 Northview Ave
Indianapolis, IN 46220
In Sum of$
$ 114.98
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-10 Reimb. 4343000 $ 114.98 I 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-Jan 2014
Signature
$ 114.98 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund