181242 01/13/2010 „;f CITY OF CARMEL, INDIANA VENDOR: 360926 Page 1 of 1
ONE CIVIC SQUARE SHAVONNE HOLTON
o. I CARMEL, INDIANA 46032 3707 N MERIDIAN ST APT 38 CHECK AMOUNT: $18.15
INDIANAPOLIS IN 46208
:z. CHECK NUMBER: 181242
CHECK DATE: 1/13/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 18.15 TRAVEL FEES EXPENSE
PRESCRIBED HT STATE BOARD Of ACCOUNTS GENFAAL FORM NG. 101 (1986)
MILEAGE CLAIM
TO TRAVE I. PER- DIEM 46 -1 DO 0 t 1 4343004
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(00(10E. BOARD, DEPARTMF7ff OR INSTITUTION)
SPEEDOMETER AUTO IE
2-0 FROM TI READING NATURE OF BUSINESS MILES i
POINT POINT I STAA7 FINISH TRAVELED PER MILE
1 C.- wire rorar e res1��� ii[`�z t �i���[c.�
MIA A IMMO O. MEM Ii ra It /ill
EN o'TrTsTdwura :�1� mmer► IMMO
II IMMO 0_111rU Mill iii �i>.r�
r.afac summommomml Num. 0.0.
.1111M 1====
1.11.1.1 1=1 1.111
11.11 11.11.11=1 IMME
AUTO LICENSE NO. TOTALS I I S 1 L
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953,1 hereby certify that the foregoing account is just and correct, that the amount claimed i eq. ly due after Al owif g all just credits
end that no pa of the same has been paid.
Date 12y r, O c v sUc)(�
(CX DE S 1 20 1 i.
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
360926 Holton, Shavonne Terms
8001 Canary Ln Apt A Date Due
Indianapolis, IN 46260
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount.
12/18/09 Reimb. Mileage 12/1 12/14/09 18.15
Total 18.15
hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20
Clerk- Treasurer
Voucher No. Warrant No.
360926 Holton, Shavonne Allowed 20
8001 Canary Ln Apt A
Indianapolis, IN 46260
In Sum of$
18.15
ON ACCOUNT OF APPROPRIATION FOR
rogram and
Cog
PO# or Board Members
INVOICE NO. ACCT #!TITLE AMOUNT
Dept
Reimb. 4343004 18.15 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
7 -Jan 2010
Signature
18.15 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund