247176 07/15/15 (9,
CITY OF CARMEL, INDIANA VENDOR: 360144
ONE CIVIC SQUARE CYNTHIA CANADA CHECK AMOUNT: $*******180.42*
CARMEL, INDIANA 46032 11508 LUCKY DAN DRIVE CHECK NUMBER: 247176
NOBLESVILLE IN 46060 CHECK DATE: 07/15/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 926150498 180.42 TRAVEL FEES & EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS - GFNFAAL FORE 110.101(1986)
MILEAGE CLAIM A
CtC C
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION 90. FOR
(OHICE,BOARD,DE}ARTT@(T OR INSTITUTION)
SPEEDOMETERAUTO )aLEAGE
DATE FROM TO READING .t" MILES a
2#2#-L5- POINT POINT START FINISH NATURE OF BUSINESS iRAVELEO
PER MILE
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AUTO LICENSE NO. TOTALS I3I c�
+ 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
JUL Q 7 2015
BY:
PRESCRIBED BY SrATE BOARD OF ACCOUM GENERAL FORM NO.101(1986)
MILEAGE CLAIM Cu
(GOVFANMENrAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFiICE,BOARD.DEPARTMENT OR iNST=109)
SPEEDOMETER
DATE
At T` FROM TO READING + MILES ® SE1 E
G NATURE OF BUSINESS Y
POINT POINT START FINISH TRAVELED AUTO PERS
V
�r
19 r
iac-b
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sits Yyxg�c— Aj4cr" 3,LT
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to °
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-� VYlI C i
5 31
�-� 11,4,
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;
end that no 'a^rt of the same has been paid.
Date ( 1 (�—
TED
JUL 01 2015
� :
PRESCRIBED BY STATE BOARD OF ACCOUIM GENERAL FOAM Ito.101(1986)
MILEAGE CLAIM
To� f�
)GOVERNMENTAL UNIT) - ON ACCOUNT OF APPROPRIATION NO. FOR
(OF.ICE,BOARD.DEPARTMEKr OR INSIIrIIIION)
FROM TO SPEEDOMETER AUTO WUAGE
READING ( NATURE OF BUSINESS IDLES @i ,5-713
2A
POINT POINT START FINISH TRAVELED PER��
TWI_r
,r
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✓t
L
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tm MCC_
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t � m ' C_ cr he c.
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c rev(
AUTO LICENSE NO. TOT , Q 1
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. �G^
ETESTC I
Pursuant to the provisions and penalties of Chapter 155,Acts 1953,1 hereby certify that the foregoing account is just and correct,that the amount claimed is legally due,after allowinq jus cre I s.
end that no p^ar•t�o the same has been paid.
Date �� Did 7 _
CA-
` TV7BY �
��� � JUL 0.7 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.
360144 Canada, Cyndi Terms
11508 Lucky Dan Dr
Noblesville, IN 46060
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
6/23/15 Reimb Mileage 3/17-5/19/15 $ 180.42
Total $ 180.42
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.
360144 Canada, Cyndi �Mowed 20
11508 Lucky Dan Dr
Noblesville, IN 46060
'fn Sum of$
$ 180.42
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-5 Reimb 4343000 $ 180.42 l hereby certify that the attached invoice(s), or
bill(s)is(are)true and correct and that the
materials or services itemized thereon for
vrhich charge is made were ordered and
received except
July 9,2015
II
Signature
$ 180.42 Accounts Payable Coordinator
Cost distribution ledger classification if 1 Title
claim paid motor vehicle highway fund