244190 04/15/15 0`/ \ CITY OF CARMEL, INDIANA VENDOR: 369038
a t ONE CIVIC SQUARE JEHAN BOLES CHECK AMOUNT: $******"40.25'
s ?Q CARMEL, INDIANA 46032 C/O ESE CHECK NUMBER: 244190
'MroN-'` CHECK DATE: 04/15/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 40.25 TRAVEL FEES & EXPENSE
,t
PRESCRIBED BY STATE BOARD OF ACCOUNTS i GENERAL FORL 710.101(1986)
MILEAGE CLAIM
TO:!—_rr
1GOVERNNENTAL UNIT)
. ON ACCOUNT OF APPROPRIATION NO. � FOR
IOF,-ICE,BOARD.DEPART1IENr OR INSTITUTION)
DATE FROM TO SPEEDOMETERREADING .p. AUTO MILEAGE
NATURE OF BUSINESS MILES a O.S 1:
POINT POINT START FINISH TRAVELED PER MILE
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AUTO LICENSE NO. TOTALS 10 Z S
+ SPEEDOMETER READINGcolumns 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 allowing all just credits
and that no pari of the same has been paid.
Date _ �- L r- t 1 U-Ct
� C� PR 2015
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.
369038 Boles, Jehan Terms
a
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
4/1/15 Reimb Mileage 1/5- 3/30/15 $ 40.25
i
s
Total $ 40.25
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.
369038 Boles, Jehan Allowed 20
In Sum of$
$ 40.25
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. CCT#/TITL AMOUNT Board Members
Dept#
1081-4 Reimb 4343000 $ 40.25 1 hereby certify that the attached invoice(s), or
I bill(s) is(are)true and correct and that the
materials or services itemized thereon for
i
which charge is made were ordered and
ireceived except
I
April 9, 2015
Signature
$ 40.25 I Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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