180840 12/30/2009 CITY OF CARMEL, INDIANA VENDOR: 361054 Page 1 of 1
ONE CIVIC SQUARE CHARLES A IMAN CHECK AMOUNT: $100.10
1,„. ro CARMEL, INDIANA 46032 11018 TAM O'SHANTER DR
o ,o CARMEL I 46032 CHECK NUMBER: 180840
CHECK DATE: 12/30/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343004 100.10 TRAVEL PER DIEMS
PRESCRIBED BY STATE BOARD OF ACCOUNTS 1 GENERAL FORDS NO. 101 (1986)
MILEAGE CL AI �,��/d�/Z�
S g Oc,p(2___ (GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
DATE FROM TO PEEDOMIETER
MILEAGE
19 POINT POINT NATURE OF BUSINESS C a
PER MILE
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1 all5 AUTO LICENSE NO. TOTALS 4
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. 36
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 claim d is legally due, after allowing all just credit
,end that no part of e sib- has been paid.
Date 91 5
i Lic0f- l p t'
k. 40(
()‘e/L-
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
...z oe r
MILEAGE CLAIM G 9
TO 7 \--Z
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO.
FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
TO
FROM SPEEDOMETER
DATE f READING AUTO MILEAGE
19 POINT POINT 1� NATURE OF BUSINESS TRAVELED a
PER MILE
1/ 2- c:, W 1 -I OW u ialla
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66 /0 q(D`7 AUTO LICENSE NO. TOTALS 1
may"
ilM 6
SPEEDOMETER READING columns are to be used only when distance between points, cannot be determined by fixed mileage or official highway map. 6 1 7
h
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 due, e.. wing all just credits
end. that no part of same has been paid.
Date OA l 0 et
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.
361054 'man, Charles Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
12/1/09 Reimb. Mileage 1012 11/24/09 100.10
1
Total 100.10
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
20
Clerk- Treasurer
Voucher No. Warrant No.
Iman, Charles Allowed 20
361054
In Sum of$
100.10
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or Board Members
INVOICE NO. ACCT #/TITLE AMOUNT
Dept
1046 Reimb. 4343004 100.10 I 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
23 -Dec 2009
&Mb
Signature
100.10 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund