183641 03/25/2010 CITY OF CARMEL, INDIANA VENDOR: 361054 Page 1 of 1
ONE CIVIC SQUARE CHARLES A IMAN
0
CARMEL, INDIANA 46032 11018 TAM 0 SMANTER DR CHECK AMOUNT: $28.00
CARMEL IN 46032 CHECK NUMBER: 183641
CHECK DATE: 3/25/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 28.00 TRAVEL FEES EXPENSE
FRPSCRIBED BY STATE BOARD OF ACCOUNTS MILEAGE CLAIM GENERAL FORM 1 iOl 0
TO-
(GOVERNMENTAL ZT) ON ACCOUNT OF APPROPRIATION NO- FOR
(OF BOARD, DEP&RTUJDff OR INSITT(1TIOX)
TO
DATE FROM 1! READING AUTO NATURE OF BUSINESS MILES
POINT POINT START FINISH TRAVELED PER MILE
A4 1) 70 !1- r'1451i Z (�YeCe (7 rC
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 135, Acts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally d H
ue, a 6T a ow g all just credits.-
and that no part i�j the me has been paid,
Date Y-�
X
BY:...
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,
361054 Iman, Charles Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
3/4/10 Reimb. Mileage 2/11/10 2/26/10 28.00
Total 28.00
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
i
Voucher No. Warrant No,
Iman, Charles Allowed 20
361054
In Sum of
r 28.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -3 Reimb. 4343000 28.00 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
1 Aj- 1
Signature
28.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I