181833 02/03/2010 CITY OF CARMEL, INDIANA VENDOR: 360144 Page 1 of 1
ONE CIVIC SQUARE CYNTHIA CANADA
1 m' o CARMEL, INDIANA 46032 11508 LUCKY DAN DRIVE CHECK AMOUNT: $64.62
NOBLESVILLE IN 46060 CHECK NUMBER: 181833
CHECK DATE: 2/312010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 64.62 TRAVEL FEES E. EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 0980
V MILEAGE CLAIM
ro C1 L.� f '.(A6 I r' !dt` 'rl 'T�'71rT ON RCCOU NT OF APPHOPRIATSON NO. FOA
(OFFICE. BOARD, DEOA I1 STRIRION)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING f-
0 POINT POINT I START FENISII NATURE OF BUSINESS MILES a
K
TRAVELED PER
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AUTO LICENSE NO.
TOTALS 19 i 1 Qs I
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. f 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
end that no part of the same bas been paid.
Dale
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'00 005 43 3 JAN Jfiitl 0 7 2010 0,
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PRESCRIBED BY STAtE BOARD Of ACCOUNTS GENERAL FORNi NO I01 GM)
MILEAGE CLAIM 11
(GOVERNMENTAL UNITI
ON ACCOUNT OF APPROPRIATION )1O. FOR
(OFT10E, BOARD. DEPA mcENT OR tNSTRUTION)
SPEEDOMETER AUTO MILEAGE
DATE FROM FROM TO READING NATURE OF BUSINESS MILES r
2 i 1- POINT POINT I FINISH TRAVELED
PER MILE
BRIM et. aii■ 11.11.1111111111=1=11111 MMI
MO 1 i Illen =amp t r +-e_ MI=
AIM' 1 =UMW. MAN
111
MEM
Mil
MN IM MININE I____ 1=MIM=IMI
M 1.11111.11=I I�
MI I
AUTO LICENSE NO. TOTALS 1 1 M`fir ?_'`-r=:
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. v I
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, atter allowing all just credits
end that no art of th same has been paid.
Date I d' 1 o 1 C.--
k 0 C- 6 5
05 Li3 ck., 7 fq- 571.17 r -71, r.
-I C
D JAN J22 U
P
7 7 1 0 16---' BY:
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.
360144 Canada, Cyndi Terms
11508 Lucky Dan Dr
Noblesville, IN 46060
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
12/14/09 Reimb. Mileage 11/12 12/14/09 52.47
12/29/09 Reimb. Mileage 12/14 12/29/09 12.15
Total 64.62
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
Voucher No. Warrant No.
360144 Canada, Cyndi Allowed 20
11508 Lucky Dan Dr
Noblesville, IN 46060
In Sum of$
64.62
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or Board Members
INVOICE NO. ACCT #/TITLE AMOUNT
Dept
1081 Reimb. 4343000 52.47 I hereby certify that the attached invoice(s), or
1081 -5 Reimb. 4343000 12.15 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
28 -Jan 2010
/L ii /A
Signature
64.62 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund