181563 01/20/2010 n -14. 1 CITY OF CARMEL, INDIANA VENDOR: 355994 Page 1 of 1
ONE CIVIC SQUARE PAMELA GRIFFITHS
CHECK AMOUNT: $20.90
CARMEL, INDIANA 46032 12906 DOUBLE EAGLE DRIVE
CARMEL IN 46033 CHECK NUMBER: 181563
CHECK DATE: 1/20/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1202 4343002 20.90 EXTERNAL TRAINING TRA
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM TA m k I r 5
,1 6/ J t TO
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
DATE FROM TO
1
SPEEDOMETER AUTO MILEAGE
READING
19 POINT POINT I START FINISH NATURE OF BUSINESS MILES ®0.A
Q
TRAVELED PER MILE
7 d D°1 MMWErniging= d ,.V'c- e a MEM A .A,a 1
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i= al c (;1 Gi a I 1
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AUTO LICENSE NO. TOTALS
1 4 I i (u
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. j�
Date 1 1 t� e.Ge
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form.
That it is duly authenticated as required
bylaw.
That it is based upon statutory authority.
That it is apparently I correct
l incorrect
Disbursing Officer
On Account of Appropriation No. for
y 0 C)
Allowed 19 m a n w
m r. K
in the sum of t i x co
y
a E.
m a
P.- m c° 1
R H
CO m 2 a
h
l .o
0
n ,4 m
(Board or Commission) p m :I' s
a
FILED
m as
r+ y
ts' ti
w n al
s y m
(Official Title) O
cb
m 43
P b� 0
A.E. ROYCE CO.. INC. )(UNCLE, )(UNCLE, p! 01136 5• 0
VOUCHER NO. WARRANT NO.
ALLOWED 20
`Pam Griffiths
IN SUM OF
$20.90
ON ACCOUNT OF APPROPRIATION FOR
Carmel IS Department
PO# Dept. INVOICE NO ACCT #/TITLE AMOUNT Board Members
1202 43- 430.02 I $20.90 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
Tuesday, January 19, 2010
or l5
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
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.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
01/11/10 I I 1 $20.90
I 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