333959 01/04/19 `%���'''F� CITY OF CARMEL, INDIANA VENDOR: 369939
® ~., CHECKAMOUNT: $********90.31*
.`. , ONE CIVIC SQUARE JENNIFER LANE
9� CARMEL, INDIANA 46032 6912 HARRIET DRIVE CHECK NUMBER: 333959
M,tiuN�o, INDPLS IN 46237 CHECK DATE: 01/04/19
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4343003 90.31 TRAVEL & LODGING
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 369939 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
JENNIFER LANE IN SUM OF$ CITY OF CARMEL
6912 HARRIET DRIVE 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.
INDPLS, IN 46237
Payee
$90.31
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Carmel Police Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
0 43-430.03 $90.31 1 hereby certify that the attached invoice(s),or 1/2/19 0 calloutmileage $90.31
1110 101 1110 101
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
Thursday,January 3,2019
&,., e"Wv",,
Jim Barlow
Chief
I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and 1 have
audited same in accordance with IC 5-11-10-1.6
20
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
i
Prescribed by State Board of Accounts �± /�
MILEAGE CLAIM .
(Governmental Unit)
On Account of Appropriation No. 43) -4
(Office,Board,Department or Institution)
DATE FROM TO
ODOMETER READING* NATURE OF BUSINESS
20 Point Point Start Finish
ffiunlf
VM V7
PQti
' l
I
i
,i
Auto License No. TOTALS
i
*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
allowing all just credits, and that no part of the same has been paid.
Date �l�� "I.v ���•/`�