251576 11/18/15 �� 4f CITY OF CARMEL, INDIANA VENDOR: 120950
ONE CIVIC SQUARE DOUGLAS HANEY CHECK AMOUNT: $ ....*"39.83'
CARMEL, INDIANA 46032 C/O DEPT OF LAW CHECK NUMBER: 251576
C/0 DEPT OF LAW CHECK DATE: 11/18/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1180 4343004 17.83 TRAVEL PER DIEMS
1180 4355100 22.00 PROMOTIONAL FUNDS
\ WELCOME TO
PLAZA PARK
PLEASE KEEP THIS TICKET
WITH YOU
Entered/Arriuee:
2015/11/04 17:41
Ticket/Billet#:68142920
Dur/Ouree:3:32:58
Paid On/Paye Le:
2015/11/04 21:14
Paid/Paye:$ 22.00
Original Fee:$ 22.00
CST:$ 8.88
PST:$ 0.00
Change:$ 0.00
MASTERCARD
SC:$ 0.00
Merchant ID:
rN«ray**«***
Seq# 109007906 01007
Purchase 15/11/04 21:15:25
Ruth# 249521
RPPROUED
escribed by State Board of Accounts
General Form No.101(1955)
MILEAGE CLAIM
City of Carmel, Indiana TO Oy \( C, 4G ne DR.
(Governmental Unit)
Department of Law - 1180 On Account of Appropriation No. 434-3004 for Mileage
(Office, Board,Department or Institution)
DATE FROM TO ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE @ 2
2015 Point Point Start Finish TRAVELED PER MILE
1 Iy f o 3-n ianG S anO retu . 46, 10S 4 l3 c.n '
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.
ursuant 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
lowing all just credits, and that no part of the same has been paid.
ate
I have examined the within claim and
Clcdm No. Warrant No.-
hereby certify as follows:
IN FAVOR OF
That it is in proper form;
That it is duly authenticated as required
by law;
That it is based upon statutory authority;
That it is apparently I correct
incorrect
On Account of Appropriation No.4343004 for
Disbursing Officer
Department of Law - 1180
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Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City FormNo.201(Rev.1995)
CITY OF CARMEL
An invoice or 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
Douglas C. Haney
Purchase Order No.
One Civic Square
Terms
Carmel, IN 46032 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1114 91111 Parking fees for City event 11 %4/2015
Total
1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor-
dance with IC 5-11-10-1.6.
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Douglas C. H2A@Y — IN SUM OF $
One Civic Square
Carmel, IN 46032
$ $22.00
ON ACCOUNT OF APPROPRIATION FOR
Department of Law 1180
r
430-55100 Promotion
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s),
1180 4355100 $22.00 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
1
r
20
� 1
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I