247297 07/15/15 y,,.c,aM
>?' CITY OF CARMEL, INDIANA VENDOR: 358411
'; ® 'r ONE CIVIC SQUARE JENNIFER HAMMONS CHECK AMOUNT: $ .....479.56"
?a CARMEL, INDIANA 46032 634 NORTHVIEW AVENUE CHECK NUMBER: 247297
�.y� oN co` INDIANAPOLIS IN 46220 CHECK DATE: 07/15/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 479.56 TRAVEL FEES & EXPENSE
GENERAL FORM 11C.101(1985)
PRESCRIBED BY STATE BOARD OF ACCOUNTS
{� MILEAGE CLAIM l e^ � 5
�SL TO
(OOvuNm ENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(Of�CE,BOARD,DEPARTf@fT OA INBTTTVZION)
_ - SPEEDOMETER AUTO E
DATE FROM TO READING + MILES a
STAR FINISH
¢ NATURE OF BUSINESS TRAVELED PER MILE
ZD a- POINT POINT
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AUTO LICENSE NO. TOTALS l
+ 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)ust and correct,that the amount claimed is legal)', due,after aliowing all just credits
and that no part of the same has been paid.
Date
300
JUL 0.7 2015
BY:
cLxinAc FOAu Nc te)uvea
PRESCRIBED BY STATE BOARD OF ACCOUNTS
MILEAGE CLAIM
TO V
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR '
(OF,-ICE,BOARD,DEPAAn.O>U OR INSTrr rr1ON)
SPEEDOMETER AUTO AG
DATE FROM TO READING + MILES Cd_�
+� NATURE OF BUSINESS TRAVELED
POINT POINT START FINISH PER MILE
i G.•,�, - W v �
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AUTO LICENSE NO. TOTALS �J
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. `1�9
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 leg.Ay due,after a' wing all Iust credits
and that nof part of the sam has been paid.
Date lR -3� 1Z
UL 0.7 2015 �( v !�I )�'�-t
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.
358411 Hammons, Jennifer Terms
634 Northview Ave Date Due
Indianapolis, IN 46220
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
I6/30/15 Reimb. Mileage 3/16-6/26/15 $ 479.56
Total i $ 479.56
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
i
Voucher No. Warrant No.
358411 Hammons, Jennifer Allowed 20
634 Northview Ave
Indianapolis, IN 46220
In Sum of$
$ 479.56
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#orBoard Members
Dept#
INVOICE NO. ACCT#/TITL AMOUNT
1081-10 Reimb. 4343000 $ 479.56 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
July 9, 2015
Signature
$ 479.56 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund