183052 03/03/2010 CITY OF CARMEL, INDIANA VENDOR: 363392 Page 1 of 1
ONE CIVIC SQUARE JAMES WHITELEY
s —'J CARMEL, INDIANA 46032 CHECK AMOUNT: $19.00
CHECK NUMBER: 183052
CHECK DATE: 3/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 19.00 TRAVEL FEES EXPENSE
PRESCRIBED BY STATL BOARD Or ACCOUR75 GERML FORM 110. 101 [19867
MILEAGE CLAIM
TO I
IGOVERNMENrAL UNm
ON ACCOUNT OF APPROPRIATION NO, FOR
IOri'ICP. BOARD, DEPARTL@rr OR 1N517T7rIlORJ
SPEEDOMETER
BATE FROM TO I READING AUTO =E c
2p
POINT POINT START FINISH NATURE OF BUSINES6 TRAVELED PER MILE
th •e r C"
S C-
7 Fr
,C.
t 1,C
it
2
,L T
2
7-
21 Z
I
AUTO LICENSE NO. TOTALS
L� 1 4 60
SPEEDOMETER HEADING 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 leg y u er atiowing all just credits
end that no art f the same has been paid.
Date t TTol
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.
363392 Whiteley, James Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1/29/10 Reimb. Mileage 1/4 1129/10 19.00
Total 19.00
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.
363392 Whiteley, James Allowed 20
In Sure of
i 19.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. 4CCT #1T1TL AMOUNT Board Members
Dept
1081 -4 Reimb. 4343000 19.00 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
19.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund