182927 03/03/2010 -CITY OF CARMEL, INDIANA VENDOR: 361923 Page 1 of 1
ONE CIVIC SQUARE TIFARAH MCMULLIN
CARMEL, INDIANA 46032 631 HOLIDAY DR CHECK AMOUNT: $3.50
FORNILLEIN46040 CHECK NUMBER: 182927
CHECK DATE: 313/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 3.50 TRAVEL FEES EXPENSE
PABSCAIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORM NO. 101 (1986)
P �p C p MILEAGE CLAIM �n
1fy��J� 1. 1i T O aya)/I 1Vt�,111�'�1V1
(GOVERNMENTAL UNIT}
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OA INSTLMION)
D�1T FROM TO
SPEEDOMETER ER AUTO un c AG
2° L POINT POINT START FINISH NATURE OF BUSINESS
Tpp L ELED
PER I.f1I.E
I
AUTO LICENSE NO. TOTALS
I
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, er aliowing all just credits
and that no part of the same has been paid.
.Date
I0 o,002-
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.
361923 McMullin, Tifarah Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1/28/10 Reimb. Mileage 1/28/10 3.50
Total 3.50
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
I
r
Voucher No. Warrant No.
361923 McMullin, Tifarah Allowed 20
In Sum of
3.50
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -2 Reimb. 4343000 3.50 1 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
25 -Feb 2010
Signature
3.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund