245889 06/03/15 �'' "* CITY OF CARMEL, INDIANA VENDOR: 361675
® I ONE CIVIC SQUARE JEREMY KASHMAN CHECK AMOUNT: $*******249.90*
x ?�, CARMEL, INDIANA 46032 18567 PILOT MILLS CT CHECK NUMBER: 245889
9��ioN - NOBLESVILLE IN 46062 CHECK DATE: 06/03/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2200 4343002 249.90 EXTERNAL TRAINING TRA
wmo�_ roc
Indianapolis International Airport
indianapolisairport.com
RECEIPT
TRAN IN TIME OUT TIME FEE CC# ,
1905 05/04 09:27 05/05 18 0 55 $36 .00 6962
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101(1955)
MILEAGE CLAIM
C14--( 0-F Co-,-rr%CI TO
(GOVERNMENTAL UNIT)
ey-,q'%eneev i-S ON ACCOUNT OF APPROPRIATED NO. FOR
(OFFICE,BOARD,DEPARTMENT OR INSTITUTION)
DATE FROM TO ODOMETER MILEAGE
READING+ NATURE OF BUSINESS AUTO MILES @ 57.5 cents
20 i S POINT POINT START FINISH TRAVELED PER MILE
03 24 Cp.rrN--e1 Wes+Meld 12038-4 1203`-+ US 31 CSC Meer 10 5 -4 5
W*-,s+A el ci CO.rrN,el 12o3 clq 12O 4 o'a US 31 CAC M e e=F 10 S -4-5
CC3_rhne1 InCAI M 0iS 1204o-4 120425 1"001 ERG Trou. irk I $ 10 35
Indio.-a{.01CoL�-r,-,-eI I2042G 12044'a 1tVDug- UtzC 'C�-C:ar%A IS 10 35
03 31 Ca ►„e1 co-'e,e1 120-4lo 120,4: b I11{!' -P-enn Nteei-E�P- (o 1 L 45
®4 01 CC."el Gr-PeenA4--id 1zoo-4-2- 12080 9CPn4t' —Pr; ori+ Wct -►NDOT Greer4' eld Lj Iet 5 5
G,-eerlAeld 00-rryn'e 12OBOco '-LOS40 ojl7{` � I�rlori+ wo. - 11�Pc�-� G.eer,fie\d 3y 19 55
04 03 C cLr,,-el I ndi CL, o I'e s 12-090% 12 o ti 24 M e e-+i w I David I-1 o n i g Z 3 13 2'&S
1nd10-n Ckpo1Is Ca. .r,el 1-2-0924 1209y=� t`Aee+: w I 0cL�id Horiiq
05 o► Carwne1, C0— 1 12z(48`1 122 13 111ir-j0i s s+,-tee+ I'^eetirJ, z+-f ►3. €3o
0'5 04 1 Ccarmel I r-id i on CP0li i 122950 122810 /)�lr o't+ `3 0 1-4. 2S
OS 05 1r,dl0.s,CLP 01 is Carmel tzzgl0 122fr40 Air o--+-f 30 1.4 .2S
09 0(�o Corrnel IMCI or,Op01"1 12'1g88 116 10 35
(,.,Cia -)o(-o11S Ccu-rr,el t7229TV 12300fc I-APO Mee{-in3 a SmOle=e 20w 1 $ Its :"5
09 03- Ll11s 123031 1230S3 (`Nps Rut!-- , Prior, income Meehi Z"Z 1�- (cs
Ir-1dlar,aPplls 1-'A0bte-Tvi11e 123053 12 .30�� CNS alio w Poor;+ . Wo.y• l�/�eQ4i 2 LA ISS Bo
05 v$ I Ca-r'me0
AUTO LICENSE NO. TOTALS 3-4 2 '2-l3 9 O
+ODOMETER 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 Ma`f -2S ,2015 /�, /`--�—
i
f
Claim No. Warrant No.
I have examined the within claim and
W FAVOR OF hereby certify as follows:
Sege rn y Qo mN� i 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}
$ z+ 3. qo
On Account of Appropriation No.
Disbursing Officer
For
2200 Li 3 q100 2--
I CERTIFY that the within bill is true and correct;
that the mileage therein itemized and for which
charge is made was ordered by me and was
Allowed 120 necessary to the public business;and that the rate
per mile is in accordance with statutes or governing
In the sum of$ ordinances,except
I
(Board or Commission)
FILED
Signature
20
Date
(Official Title)
BOYCE FORMS—SYSTEMS 1-800-382-8702 01136
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.
Payee
Jeremy Kashman Purchase Order No.
0 Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s) Amount
5/28/2015 0 Mileage $ 213.90
5/5/2015 0 Parking at airport for trip to DC $ 36.00
Total $ 249.90
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
VOUCHER NO WARRANT NO.
Jeremy Kashman ALLOWED 20
0 IN SUM OF$
$ 249.90
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#(TITLE AMOUNT
DEPT# I hereby certify that the attached invoice(s), or
0 0 2200-4343002 $ 213.90 ,bill(s) is (are)true and correct and that the
0 0 2200-4343002 $ 36.00 imaterials or services itemized thereon for
which charge is made were ordered and
received except
6/1/201.5
Signature
City Engineer
Cost Distribution ledger classification if Title
claim paid motor vehicle highway fund
i