182054 02/03/2010 ,,7 CITY OF CARMEL, INDIANA VENDOR: 362099 Page 1 of 1
FJ ONE CIVIC SQUARE KIM PREUSCH CHECK AMOUNT: $34.65
k.,. CARMEL INDIANA 46032 1530 DEERFIELD DRIVE PLAINFIELD IN 46168 CHECK NUMBER: 182054
CHECK DATE: 2/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 34.65 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENF.RAL FORM NO. 101 (1986)
MILEAGE CLAIM
M
i,?--ec,- ya\rKs TO
(GO VERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OF7CE, BOARD. DEPART1EENT OR INSTOUTION)
FROM TO I SPEEDOMETER
READING AUTO MILEAGE C
DATE NATURE OF BUSINESS MILES tj 5
z C POINT POINT START TRAVELED
PER MILE
NM INIZNIMI
L II i-
1
�MN
11111=1 1
IIIIIMMI =ME
iiiii
J 1 1 I
i r
AUTO LICENSE Q. TOTALS all L 5
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, I hereby certify that the foregoing account is just and correct. that the amount claimed is legally due, after aliowing all just credits
end that no part of the same has been paid.
Date
q3q V 1
11( 000 r-N r- Oil 5 57 r—, .7,11 r.
,•?0 ,iit;: ■,,Lc::. f_ i
4� J Aft 1 1 i 10 y"
(r
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.
362099 Preusch, Kim Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
12/18109 Reimb. Mileage 12/8 12/18/09 34.65
Total 34.65
1 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.
362099 Preusch, Kim Allowed 20
In Sum of
34.65
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or Board Members
INVOICE NO. ACCT #ITITLE AMOUNT
Dept
1081 Reimb. 4343000 34.65 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
28 -Jan 2010
��CYil /�17. Gam'
Signature
34.65 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund