244495 04/21/15 yi ur..4.4q�f
a. y CITY OF CARMEL, INDIANA VENDOR: 366239
{'; ® ,l ONE CIVIC SQUARE MONICA HADDOCK CHECK AMOUNT: $""'«'119.71
:Q' CARMEL, INDIANA 46032 C/O ESE CHECK NUMBER: 244495
'Mrro„�� CHECK DATE: 04/21/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 119.71 TRAVEL FEES & EXPENSE
GQWAAL FORM 110.101(1996)
PRFSCRI9ED BY STATE BOARD OF ACCOUNTS
MILEAGE CLAIM
pm_" To
IpovF�►i�TAL UNn1 ON ACCOUNT OF APPROPRIATION NO_ FOR
(OFFICE,BOARD,DEPARTMENT OR INSrr=ON)
FROM TO SPEEDOMETER AUTO
DAT READING + NATURE OF BUSINESS MILES Chi
POINT POINT START FINISH TRAVELED PER MILE
"Ace ITU
b NCL 14
U
CTJ MCC -- 4MCC
U
p a sp2
—� ��-
0
L
2 1 CT
LA 1 0'5s
ME
-- lU
O
0N CJL-
MCC
®m C7
MCC
9r7 114 CC.9_1 -
2 �
- L -�
b)
G
U
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 allowing all just credits
and that no part of the same has been paid.
Date Q 12-1
C
` APR 0.8' 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.'
366239 Haddock, Monica Terms
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
4/2/15 Reimb Mileage 2/5-4/5/15 $ _ 119.71
Total $ 119.71
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.
366239 Haddock, Monica Allowed 20
In Sum of_$
i
$ 119.71 i
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO'#or INVOICE NO. CCT#/l ITL AMOUNT I Board Members
Dept#
1081-2 Reimb 4343000. $ 119.71 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 ordored and
f received except
L.
April 16, 2015.
i
Signature
$ 119:71Accounts Payable-Coordinator
Cost-distribution ledger classification if Title
P highway claim aid motor vehicle hi hwa fund
-.
i`