248532 08/12/15 �; CITY OF CARMEL, INDIANA VENDOR: 369165
® ONE CIVIC SQUARE KIEFER SUMMERS CHECK AMOUNT: S""""'"'"64.40"
r, ,?� CARMEL, INDIANA 46032 C/O PARKS CHECK NUMBER: 248532
'M,;ro�� CHECK DATE: 08/12/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343000 64.40 TRAVEL FEES & EXPENSE
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 110.IW 11985)
MILEAGE CLAIM k
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VERNMENTAL 4127
ON ACCOUNT OF APPROPRIATION NO. FOR
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+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. C'44D
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 allowing all just credits
and that no, art of�e mijL0 has been paid.
Date zly
JUL 2 9 2015
BY:-
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.
369165 Summers, Kiefer Terms
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
7/27/15 Reimb Mileage 3/26 - 7/9/15 $ 64.40
Total $ 64.4V
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.
369165 Summers, Kiefer Allowed 20
In Sum of$
$ 64.4E)
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TITL AMOUNT Board Members
Dept#
1082-11 Reimb 4343000 $ 64.ho 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
August 6, 2015
Signature
$ 64.41 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund