250246 10/07/15 CITY OF CARMEL, INDIANA VENDOR: 366239
® it ONE CIVIC SQUARE MONICA HADDOCK CHECK AMOUNT: $ ...."185.19*
CARMEL, INDIANA 46032 C/O ESE CHECK NUMBER: 250246
CHECK DATE: 10/07/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 185.19 TRAVEL FEES & EXPENSE
GENERAL FORM 110.IDI 11986)
PMCRIaED BY STATE BOARD OF ACCOUNTS
MILEAGE CLAIMpan ��;�� ���J'L
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POINT POINT START FINISH TRAVELED PEA
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AUTO LICENSE NO- TOTALS 22
+ 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 part of the same has been paid.
Date S
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x�.x •�1�F�cTT-
SEP 2 2 2015
�'� BY. i
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.
366239 Haddock, Monica Terms
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
9/18/15 Reimb' Mileage 7/30- 9/18/15 $ 185.19
Total $ 185.19
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
Voucher No. Warrant No.
366239 Haddock, Monica Allowed 20
In Sum of$
$ 185.19
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-2 Reimb 4343000 $ 185.19 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
October 1, 2015
Signature
$ 185.19 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund