241547 01/27/15 '';� CITY OF CARMEL, INDIANA VENDOR: 366785
.I �;• ONE CIVIC SQUARE
BONNIE LEWIS CHECK AMOUNT: $********18.32*
9� _�; CARMEL, INDIANA 46032 11110 CLAYPOOL COURT CHECK NUMBER: 241547
M,�roN,.�` SAN ANTONIO TX 78230 CHECK DATE: 01127/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1301 4343004 REISSUE 18.32 REISSUE CK 215700
CITY OF CARMEL, INDIANA VENDOR: 366785 Page 1 of 1
ONE CIVIC SQUARE BONNIE LEWIS CHECK AMOUNT: $18.32
�a CARMEL, INDIANA 46032 C/O COURT
CHECK NUMBER: 215700
CHECK DATE: 12/18/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1301 4343004 REIMB 18 . 32 TRAVEL PER DIEMS
1
I
Prescribed by State Board of Accounts General Form No.101(1955)
MILEAGE CLAIM /30/'�fx/e Left// S
TO DR.
(Governmental
On Account of Appropriation No. for
Office,Board, epartment or Institution
DATE FROM TO ODOMETER READING' NATURE OF BUSINESS AUTO MILES MILEAGE @ o$SS
�07 y 20� Point Point Start Finish TRAVELED PER MILE
-T I SSE Y 7eq,AJ i n,16 3
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. I
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 credi ,and that no part of the same has been paid.
I
1
Date Y
Prescribed by State Board of Accounts
City Form No.201 (Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or 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.
P yee
Purchase Order No.
f/ Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
l 6 q ! acc�a
-P-Lo -I—
Total �,3
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
i
Claim No. Warrant No. I have examined the within claim and
hereby certify as follows:
IN FAVOR OF
That it is in proper form;
That it is duly authenticated as required
by law;
That it is based upon statutory authority;
That it is apparently correct
$ incorrect
On Account of Appropriation No. for
Disbursing Officer
0 Allowed 20 o
trK
in the sum of$
CD ::r
ID
r-rr
CD
CD
. �
II p (D Q
I (Boyd or Commission)
m cep
FaM cp
(O. i
CD
o q
Q m
(Official rnla) � � m
in
m
i
II
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF $
ON ACCOUNT OF APPROPRIATION FOR
Board Members
o PT.r INVOICE NO: ACCT#(TITLE AMOUNT I hereby certify that the attached invoice(s), or
30 �� 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
20(?
#rll"J�e
Cost distribution ledger classification if Titl
claim paid motor vehicle highway fund