184317 04/14/2010 CITY OF CARMEL, INDIANA VENDOR: 360926 Page 1 of 1
5 i ONE CIVIC SQUARE SHAVONNE HOLTON CHECK AMOUNT: $38.00
CARMEN, INDIANA 46032 3707 N MERIDIAN ST APT 3B
4 INDIANAPOLIS IN 46208 CHECK NUMBER: 184317
CHECK DATE: 4/1412010
DEPARTMENT ACCOU P O NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 38.00 TRAVEL FEES EXPENSE
FRI$CRISED ST STATE BOARD OF ACCOUNTS GENFAAL FORM NO. 101 (i Fn6)
MILEAGE CLAIM 1RAi E L PE?- DIE
(GOVERNMENTAL UNIn
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DETARTQ]R OR INSttTU iOg)
SPEEDOMETER
DA,TT£ NATURE OF BUSINESS y FROM TO READING ASS '�J MiL)r
li r POINT POINT START FINISH TRAVELED
PER MILE
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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, 1 hereby certify that the foregoing account is just and correct, that the amount claimed i slarvally due, her aliowing all just credits
end that n nn part of the same has been paid. l/
Date
y3 00
�f�
ACCOUNTS PAYABLE VOUCHER
y 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.
360926 Holton, Shavonne Terms
8001 Canary Ln Apt A Date Due
Indianapolis, IN 46260
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
319110 Reimb. Mileage 1119 313110 38.00
Total 38.00
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,
360926 Holton, Shavonne Allowed 20
8001 Canary Ln Apt A
Indianapolis, IN 46260
In Sum of
38.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #t`/TITLE AMOUNT Board Members
Dept
1081 -1 Reimb. 4343000 38.00 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
8 -Apr 2010
Signature
38.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund