318975 11/22/17 CITY OF CARMEL, INDIANA VENDOR: 360144
ONE CIVIC SQUARE CYNTHIA CANADA CHECK AMOUNT: $*******217.95*
=q CARMEL, INDIANA 46032 11508 LUCKY DAN DRIVE CHECK NUMBER: 318975
NOBLESVILLE IN 46060 CHECK DATE: 11/22/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 135.93 TRAVEL FEES & EXPENSE
1082 4343000 REIMB 82.02 TRAVEL FEES & EXPENSE
Voucher No. Warrant No.
360144 Canada, Cyndi Allowed 20
11508 Lucky Dan Dr
Noblesville, IN 46060
In Sum of$
$ 217.95
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or
Dept# INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1082-14 Reimb 4343000 $ 82.02 1 hereby certify that the attached invoice(s), or
1081-5 Reimb 4343000 $ 135.93 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
November 15, 2017
Signature
$ 217.95 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
w��1c?��; C--ICadCOD
eRFscnlarD BY srA:E BOARD of AccoDNrs
GEMMIAL FORA 110.101(mg)
MILEAGE CLAI2 C �� �
rol \,,n t
(GOVERNMENTAL UNIT) t.
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFIM BOARD,DEPARTbOXT OR INn TrUTION)
SPEEDOMETER AUTO DIIi SC AGE
DATE FROM To READING + MILES ® T3 S c
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MILE
W5,ln-7 ll7 Wtc,T I-7 �--Y�c� c.to
1Tw
Com_ — 1
- -- ti
t, l
-� - W
lc3n CA
k ; cyU
C
-_- -� v i
.
X11 1-0
C. 5c D tYl -
t �
-7C�5a
7 ti
AUTO LICENSE NO. TOTALS ( a 1
+ 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 i.legally due,a e ' wiaq 'ust credits;
end that no part 1of}the same has been paid_.
Date
po
IRK ,tea' „l \
NOV 14 2017 '
BY:
CMMAL FORM VC 121 119M
t-MCMDED Dr STATE BOARD Or ACCOUNTS
MILEAGE CLAIM C` i 't � � i i b
To_� ted,
Nd6e�v t Ile,'Xi%J Li l Oub
(GOVEMENrAL m+m ON ACCOUNT OF APPROPRIATION NO. FOR —
'- Lora=BOARD.DUARTUM OR UIST=IoN) -�
SPEEDOMETER AUTO WZAC`
FROM — TO - READING + bfILE9 @ D_J
NATURE OF BUSINESS TRAVELED
L t POINT POINT START FINISH PER 1dRE
c
LL
D C C— '^
.00I\ � foci s 1
CLak -4-fa LC Jh
r
C . a'
J
of L" _ !
1 c! �rc�
N-
e'
JDL MGL c
4 O
.-. C-g
M�
C C.. vu-
mc. r\ ;
feAr � - �-
AUTO LICENSE NO. TOTALS 1
+ 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 1953,1 hereby certify that the foregoing account is just and correct,that the amount claimed is legally due,after aliowing all Just credits.
and thatart I the same has been paid. C
Date 1
� � ,,,� 3q3po bit
NOV 1 4 � �r '
2017
I
BY.
I
i
GF.IDAAL FOAM 110 101119951
PRESCRIBED BY STATE BOARD OF ACCOUNTS
MILEAGE CLAoiM,� I��,•oc��( L Z tc
1 WI
VMENrALU11M ON ACCOUNT OF APPROPRIATION NO" FOR /-Ouz)
tOFACE.BOARD.BEPARTAWT OB B13=10N) — —1 lIl
SPEEDOMETER
FROM TO I^ READING + AM= (y- E a
AAD NATURE OF BUSINESS TRAVELED
POINT PO1N1' START FINISH PER tdI1.E
co P 4'��-- _
--- aO T _—.� �_ - •rte S` -
—�_ C c-
�<
r-rn 'n +7
ra
S r _
1�in✓�(� f -VOL r_
— o I
ry c _
LA A
A-q �� '•
- 31
in M n . I
_t U ti�T
- �
M
SL mG -� cn 1
_ _ T I I
- c r 1-o s31
44
AUTO LICENSE NO. TOTALS I 136 r 343
+ SPEEDOMETER READING columns are to be used only when dislance between points cannot be determined by fixed mileage or official highway map.
Pursuant to Ute provisions and penalties of Chapter 155,Acts 1953,I hereby certify that the foregoing account is lust and correct,that the amount claimed Is legally due,after aliOwing alt lust credits.-
end that no art of the Ste has been paid. i --
Date
3`� (Devi
RFc �
Id
NOV 1 4 2011
sY: