241456 1 /27/2015 (9,
CITY OF CARMEL, INDIANA VENDOR: 369038
ONE CIVIC SQUARE JEHAN BOLES CHECKAMOUNT: $********38.64*
CARMEL, INDIANA 46032 a0 ESE CHECK NUMBER: 241456
CHECK DATE: 01/27/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 38.64 AUTO REPAIR & MAINTEN
PRESCRIBED BY STATE HOARD OF ACCOUNTS GENERAL FORM NO.101(1086)
MILEAGE CLAIM
(GOvERWdFMAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD,DEPARTHIIir OR 1NSTTTMION)
DATE
FROM TO SPEEDOMETER
READING { AUTO MILEAGE
n
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED @
�J PEA
L�
d - A CC
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O
CC
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C
' C C
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it 1A 11 cc
11 C
1 i 2.14 F to F M.CC
I9.Cc-
i 6 cc
' 0 r_c
c
i 'O I F 0 k ---/It cc
t CC
F 17 , E Cc
12 E c
Al CC-
AUTO
AUTO LICENSE NO. TOTALS z
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. c/ V!
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 allowing all just credits;
end that no part of the same has been paid.
Date
�3f 1,-q
JAN 12 2015
'3y
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.
Boles, Jehan Terms
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
1/5/15 Reimb Mileage 9/22- 12/22/14 $ 38.64
Total $ 38.64
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.
Boles, Jehan ! Allowed 20
In Sum of$
� I
$ 38.64
1
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-4 Reimb $ 38.64 1 hereby certify that the attached invoice(s), or
�jy3aac 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
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January 15, 2015
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Signature
$ 38.64 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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