251145 11/04/15 CITY OF CARMEL, INDIANA VENDOR: 357976
ONE CIVIC SQUARE BENJAMIN JOHNSON CHECK AMOUNT: $""*""**'41.98*
=4 CARMEL, INDIANA 46032 11182 HARRISTON DRIVE CHECK NUMBER: 251 145
FISHERS IN 46037 CHECK DATE: 11/04/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 41.98 TRAVEL FEES & EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS 0C 19 Z015 I GENERAL FORM NO.101(IBB6)
BY. MILEAGE CLAIM
TO 1f
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD.DEPARTMENT OR INSTITUTION)
DAITE FROM TO SPEEDOMETER
V
1 READING + AUTO MILEAGE
POINT NATURE OF BUSINESS MILES C� S7's- a
POINT START FINISH TRAVELED PER MILE
17977cl A-4 A4,�
ll
W �- (l
UT !PAAX' OUT)::Saw M 11
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S M CC- W2FST LE S ITr �21
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ivlo e?l — It 3
ly C-4 at t --("tW 1 rE u
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MO
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— EUyvi M c L_ I .t
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AUTO LICENSE NO. TOTALS f Imo/Q V
+ SPEEDOMETER READING coiulnns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. I I V VV
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 a after aliowing all just credits
end that no part of the same has been paid.
Date
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.
357976 Johnson, Ben Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
10/19/15 Reimb Mileage 7/31 - 9/28/15 $ 41.98
Total $ 41.98
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
i
Voucher No. Warrant No.
357976 Johnson, Ben Allowed 20
In Sum of$
$ 41.98
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
Po#or Board Members
INVOICE NO. ACCT#/TITL AMOUNT
Dept#
1081-99 Reimb 4343000 $ 41.98 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 20, 2015
Signature
$ 41.98 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund