255466 02/19/16 a��"4�qM
aY CITY OF CARMEL, INDIANA VENDOR: 367093
.I� i; ONE CIVIC SQUARE ALYSSA CLARK
CHECK AMOUNT: $********43.17*
s. � CARMEL, INDIANA 46032 C/O PARKS CHECK NUMBER: 255466
''`'a�oa' � CHECK DATE: 02/19/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 021616 43.17 TRAVEL FEES & EXPENSE
Voucher No. Warrant No.
367093 Clark, Alyssa I Allowed 20
'r
i
In Sum of$
$ 43.17
I
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
i
PO#or Board Members
INVOICE NO. ACCT#/TITL AMOUNT
Dept#
1081-4 Reimb 4343000 $ 43.17 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
February 10, 2016
Signature
$ 43.17 Accounts Payable Coordinator
Cost distribution ledger classification if { Title
claim paid motor vehicle highway fund
1
4
I
f.
FA[SCAIDW HY STATE HOARD OF ACCOUNTS 4 GFNAAAL FOAM 110.161 Bob)
MILEAGE CLAIM cio'�+'E'�E To-
10f?VFANMfNTA1 UNITI i
ON ACCOUNT OF APPROPRIATION NO. FOR
' I6i7ICC,BOARD.e[TAATIQ:lFI'Op 1NSCCRTTIgN) '
._SPEEDOMETER AUTO I,tILEAC+£
DATE FROM y TO READING + SEs / '51S a
--- POINT POINT START FINISH NATURE OF BUSINESS 1TiAV£LHt3 MIL�-
PER MILE
MILE
45 1'3
12 114 1
QC
7MCC
12 23 CC
I 1z Z Cc FA 1 3
1z Z
Cc
CC
MCC ! 3
1 91 MCC
j 3
iq RCC
s
b
2 cc
Z 71
CC
"I FH Ci 3
i ZFn F __ --
POE-
4 fte
CC Y J
AUTO LICENSE NO. TOTALS
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by lixed.mileage or official highway map.
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 parlyof the same has been paid.
Date L " - `
•
FES -
8 2016
BY _ - .