183650 03/25/2010 CITY OF CARMEL, INDIANA VENDOR: 355319 Page 1 of 1
0 ONE CIVIC SQUARE MICHAEL KLITZING CHECK AMOUNT: $44.76
CARMEL, INDIANA 46032 1550 REDSUNSET DRIVE
aN BROWNSSURC IN 46112 CHECK NUMBER: 183650
CHECK DATE: 3125/201D
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4343000 44.76 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO, IDI {198%
MILEAGE CLA
(GOVERNMENTAL Win
ON ACCOUNT OF APPIIOPRIATION NO. FOR
(OFFECE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER
DATE FROM To READING AUTO E
NATURE OFBUSINESS MILES c
POINT 4 POINT START FINISH TRAVELED P LF
cr 2. p
N0V a 2.� .S it 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 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after aliowing all just credits
and that no part of the same has been paid.
Date 3 I t
Li 3`i3pv�
MAR 15 lglo
r- I
Michael Klitzing
Mileage Reimbursement Request
DATE DESTINATION MILES RATE AMOUNT
11/03/09 AO /MC round -trip (return thru CP -West) 3.0 $0.55 $1.65
11/04/09 AO /MC round -trip 2.6 $0.55 $1.43
11/10/09 MC /AO round trip 2.6 $0.55 $1.43
11/12/09 MC /AO one way 1.3 $0.55 $0.72
11/17/09 MC /AO one way 1.3 $0.55 $0.72
11/19/09 MC /AO one way 1.3 $0.55 $0.72
11/20/09 MC /AO one way 1.3 $0.55 $0.72
11/23/09 AO /MC round -trip 2.6 $0.55 $1.43
11/24/09 AO /MC round -trip 2.6 $0.55 $1.43
11/24/09 AO /MC one way 1.3 $0.55 $0.72
11/30/09 AO /MC round -trip 2.6 $0.55 $1.43
g L�� R NovembzrTta!
a
12/01/09 AO /MC round- trip 2.6 $0.55 $1.43
12/02/09 AO /MC one way 1.3 $0.55 $0.72
12/03/09 AO /MC round -trip 2.6 $0.55 $1.43
12/04/09 AO /MC one way 1.3 $0.55 $0.72
12/07/09 AO /MC round -trip 2.6 $0.55 $1.43
12/08/09 MC /AO round trip 2.6 $0.55 $1.43
12/09/09 AO /MC round -trip 2.6 $0.55 $1.43
12/14/09 AO /MC one way 1.3 $0.55 $0.72
12/16/09 AO /MC one way 1.3 $0.55 $0.72
12/17/09 AO /MC round -trip 2.6 $0.55 $1.43
12/18/09 AO /MC one way 1.3 $0.55 $0.72
12/21/09 AO /MC round -trip 2.6 $0.55
12/22/09 MC /AO round trip 2.6 $0.55 $1.43
12/30/09 MC /AO one way 1.3 $0.55 $0.72
of R-F ,.d''4' 4z'�SA'3 L `ii N3 L R i
a E ,a.�a December Total i 28':6
01/05/10 AO /MC round -trip 2.6 $0.50 $1.30
01/11/10 AO /MC round -trip 2.6 $0.50 $1.30
01/12/10 AO /MC round -trip 2.6 $0.50 $1.30
01/13/10 AO /MC one way 1.3 $0.50 $0.65
01/14/10 MC /AO one way 1.3 $0.50 $0.65
01/19/10 MC /AO one way 1.3 $0.50 $0.65
01/21/10 MC /AO one way 1.3 $0.50 $0.65
01/22/10 AO /MC one way 1.3 $0.50 $0.65
01/26/10 AO /MC one way 1.3 $0.50 $0.65
02/03/10 AO /MC round -trip 2.6 $0.50 $1.30
02/10/10 AO /MC round -trip 2.6 $0.50 $1.30
02/22/10 AO /MC round -trip 2.6 $0.50 $1.30
02/23/10 AO /MC round -trip 2.6 $0.50 $1.30
02/23/10 AO /MC one way 1.3 $0.50 $0.65
02/24/10 AO /MC round -trip (return thru CP -West) 3.0 $0.50 $1.50
02/25/10 AO /MC round -trip (return thru CP -West) 3.0 $0.50 $1.50
c r ".R 2
3 ,.,a A January Total 33 34£ ,x$1 65
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
355319 Klitzing, Michael Terms
1550 Redsunset Dr Date Due
Brownsburg, IN 46112
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
3112110 Reimb Milea e 11 /3/09 2/25/10 44.76
Total 44.76
I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and 1 have audited same in accordance
with IC 5- 11- 10 -1.6
1 20
Clerk- Treasurer
Voucher No. Warrant No.
355319 Klitzing, Michael Allowed 20
1550 Redsunset Dr
Brownsburg, IN 46112
In Sum of$
44.76
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 Reimb 4343000 44.76 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
44.76 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund