245444 05/20/15 �r CSA _
;,' '; CITY OF CARMEL, INDIANA VENDOR: 367093
t. ONE CIVIC SQUARE ALYSSA CLARK CHECK AMOUNT: $**......86.25"
f. =4 CARMEL, INDIANA 46032 C/O PARKS CHECK NUMBER: 245444
'M,/r���o ' CHECK DATE: 05/20/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 86.25 TRAVEL FEES & EXPENSE
i
GENERAL FORM 110.101(19667
PRESCRIBED BY STATE BOARD OF ACCOUNTS C)–CK MILEAGE CLAIM AI�Q
TO
ES (GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
IOHICE,BOARD,DEFAATVENT OR INST1T1rrION)
SPEEDOMETER AUTO
DATE FROM To READING + NATURE OF BUSINESS MILES �ERc
POINT POINT START FINISH TRAVELED PERS
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2 M
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20 FD- CC _
— 2 C.
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13
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` J AUTO LICENSE NO. _ TOTALS (�(D
+ 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
t:. 3 7D
t
i MAY 06 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
367093 Clark, Alyssa Purchase Order No.
Terms
Invoice Invoice
Date Number Description
(or note attached invoice(s)or bill(s)) PO#
5/1/15 Reimb Mileage -.. - 4/30/15 Amount
$ 86.25
I hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordanTotal $ 86.25
with IC 5-11-10-1.6
, 20
Clerk-Treasurer
Voucher No. Warrant No.
367093 Clark, Alyssa
Allowed 20
In Sum of$
$ 86.25
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
Board Members
PO#or INVOICE NO. kCCT#/TITLE AMOUNT
Dept#
1081-4 Reimb 4343000 $ 86.25 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 ordered and
received except
May 12, 2015
1PA0MVK"
Signature
$ 86.25 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund