246723 06/30/15 t Cqq -
J/ ,� CITY OF CARMEL, INDIANA VENDOR: 368615
'il ONE CIVIC SQUARE ANDRE BROADNAX CHECK AMOUNT: $********19.60*
s. ?� CARMEL, INDIANA 46032 C/O ESE CHECK NUMBER: 246723
'M;;oN�` CHECK DATE: 06/30/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 19.60 TRAVEL FEES & EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 110.101(1886)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
COPPICE,BOARD•DEPARTMENT OR INSTTTVTION)
DZIE FROM TO SPEEDOMETER AUTO MILEAGE
ZQ READING + NATURE'OF BUSINESS MILES p� 4
�� POINT POINT START FINISH TRAVfiLED PER MILE
Wt
Dag,
a
AUTO LICENSE NO. TOTALS �b
+ 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 Jue,after allowing all
Jus; cred-
end th the-same has been paid.
Date
JU - 01� - - -•'
`U N 2
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.
368615 Broadnax, Andre Terms
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
6/16/15 Reimb Mileage 5/7- 5/21/15 $ 19.60
Total $ 19.60
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
it
i
Voucher No. Warrant No.
368615 Broadnax, Andre i Allowed 20
I
In Sum of$
$ 19.60
i
ON ACCOUNT OF APPROPRIATION FOR I
108 -ESE
i
PO#or INVOICE NO. ACCT#/TITL AMOUNT Board Members
Dept#
1081-10 Reimb 4343000 $ 19.60 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
I
June 25, 2015
Signature
$ 19.60 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I
I