246220 06/17/15 4
CITY OF CARMEL, INDIANA VENDOR: 369038
ONE CIVIC SQUARE JEHAN BOLES CHECK AMOUNT: $********20.70*
CARMEL, INDIANA 46032 C/O ESE CHECK NUMBER:• 246220
CHECK DATE: 06/17/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 20.70 TRAVEL FEES & EXPENSE
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PRESCRIEED BY STATE BOARD OF ACCOUNTS GENERAL FORM 110.101(lab)
Ir
MILEAGE CLAIM
(WVEI1NMENTAL UNlrt '
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFRICE,BOARD.DElARTUX"OR IMS ITIrr10N)
SPEEDOMETER
DATE FROM TO READING ( MILES CSA MILEAGE 4
POINT POINT START FINISH
NATURE OF BUSINESS TRAVELED `—'ER MILE
PER MILE
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114 C
dr cc
Cc
cc
41 29115 -W T C
h IACC
UP AV I C
3
AUTO LICENSE NO. TOTALS 36/ 20 '70
+ 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 her 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. r
Date � r
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JUN - 2 2015
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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
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
5/26/15 Reimb Mileage 4/1 - 5/12/15 $ 20.70
Total is 20.70
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
120
Clerk-Treasurer
Voucher No. Warrant No.
369038 Boles, Jehan Allowed 20
In Sum of$
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$ 20.70
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT I Board Members
Dept#
1081-4 Reimb 4343000 $ 20.70 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
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received except
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June 11, 2015
Signature
$ 20.70 i Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund