183617 03/25/2010 CITY OF CARMEL, INDIANA VENDOR: 358408 Page 1 of 1
g 4� ONE CIVIC SQUARE TIFFANY BUCKINGHAM CHECK AMOUNT: $117.00
CARMEL, INDIANA 46032 5130 PRIMROSE AVE
ToN.o INDIANAPOLIS IN 46205 CHECK NUMBER: 183617
CHECK DATE: 3/25/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 117.00 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. IB) 11986)
MILEAGE CLAIM
To 1'Gl(1 LJyC \V� (71�/1�lVln
1GOVERNNENTAL UTP
ON ACCOUNT OF APPROPRIATION NO. FOR
Ef El l
(OF,w,L BOARD, DEPART zxT OR INSTrnmox)
SPEEDOMETER
DATE FROM TO I READING AUTO MILEAGE
NATURE OF BUSINESS MILES d —50 C
_l.SL POINT POINT START FINISH TRAVELliO PER MILE
:6 C
MD A O'
A 1 7�r M in 60 V1 by)
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AUTO LICENSE NO. TOTALS
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, of aliowing all just credits
end that no part of the same has been paid.
Date
sL 1 S,''.� i 7 2010
lay:
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,
358408 Buckingham, Tiffany Terms
5130 Primrose Ave
Indianapolis, IN 46205
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
2/19110 Reimb. Mileage 1/5 2119110 117.00
Total 117.00
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.
358408 Buckingham, Tiffany Allowed 20
5130 Primrose Ave
Indianapolis, IN 46205
In Sum of
117.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -2 Reimb. 4343000 117.00 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 -Mar 2010
Signature
117.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund