183618 03/25/2010 CITY OF CARMEL, INDIANA VENDOR: 360144 Page 1 of 1
ONE CIVIC SQUARE CYNTHIA CANADA
CHECK AMOUNT: $96.15
CARMEL, INDIANA 46032 11508 LUCKY DAN DRIVE
i:u: io NOBLESVILLE IN 46060 CHECK NUMBER: 183618
CHECK DATE: 3/25/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 96.15 TRAVEL FEES EXPENSE
PRTSCRIBCD By STATE BOARD Or ACCOUNTS GENERAL FORM 110. 101 (1986)
MILEAGE CLAIM C_,�
ro
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DESAAT XWT OR INSTnUTION)
SPEDR
OD;Tt FROM TO I READING ING AUTO a,
NATURE OF BUSINESS AV (U
2 t .J POINT POINT START FINISH TRAVELED
PEA MILE
1,�i 1 L IC.•' ICJ 1
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AUTO LICENSE NO.
TOTALS 1 1 �.o, S IU. a
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 the same has been paid.
Date I L!
2010
lay
PR[SCRIZED BY STATE BOARD Of ACCOUNTS GUEN&L FORM Nc. 101 )1986)
MILERGE CLAIM
(GOO RNS1ENrAL UNl'n
ON ACCOUNT OF APPROPRIATION NO. FOR
tOMCE. BOARD, DEPARTUM OR INSr=1ON)
SPEEDOMETER
DATE FROM To READING t AUTO MILEAGE
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER WL.E
re
1
�Z n
kt> 1-3 L4 75
Y1i111 L
Ll
D
cf
C'.
rlra C_�l�l n r
1 62- N I A 3
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 1453, I hereby certify that the foregoing account is just and correc"t5that�thelamounLclaimed is legally due, after allowing all just credits
e
and that tpa <t of the same has been paid.
Date
JaYa......................
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
3/9/10 Reimb. Mileage 1/4 3/9/10 96.15
Total 96.15
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
96.15
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -5 Reimb. 4343000 96.15 k 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
96.15 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund