184852 04/27/2010 CITY OF CARMEL, INDIANA VENDOR: 362749 Page 1 of 1
ONE CIVIC SQUARE KELSEY MILLER CHECK AMOUNT: $91.30
CARMEL, INDIANA 46032 13259 EASTWOOD LN
FISHERS IN 46038 CHECK NUMBER: 184852
CHECK DATE: 4/27/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 91.30 TRAVEL FEES EXPENSE
PACSCAIBED BY STATE BOARD Or ACCOUNTS GENERAL FORM 110. 101 (1985) MILEAGE CLAIM
TO
(oovuNaENrALUIn N
E` ON ACCOUNT OF APPROPRIATION NO- FOR
(O CF, BOARD, DEPAX7WW 00 INSrMJTION)
SPEEDOMETER
FROM TO AUTO MILEAGE DATE READING
24 POINT P03NT START FINISH NATURE OF SU53NE56 MILES C4 �JO
TAAV£LED PER MILE
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TO LICENSE NO. TOTALS I 1
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 ioregoing account is just and correct, that the amount claimed is leg y u after 110 g Bt cr d
end that no part f the sa a bee❑ paid.
r
Date
APR 5 2010 r ffqqrgo 2
BY: a
PRfSCRi6CP HT STATC BOARU Of ACa:0UNi5 GENSRAL FORM 71G- 101 t198b)
MILEAGE CLAIM
TO ll..
ON ACCOUNT OF APPROPRIATION N0. FOR
(Of1GE, BOXFtV, AR OR 1lf5rrTUr1QN)
FROM TO SPEEDOMETER AUTO NSLEAGE
PATE I READING
POINT POINT START FINISH NATURE OF BUSINESS Tp LED a E'er r
PER MILE
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Vnill A
AUTO LICENSE NO. TOTALS 1 g O
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. 0 I
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, alter aliowing at] just credits r
2nd that no part f the sam has been paid.
Date
a
3
VVI App 15 zoo $qq
t
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must ,;,how; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
362749 Miller, Kelsey Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
416110 Reimb. Mileage 115 415/10 91.30
Total 91.30
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20_
Clerk- Treasurer
Voucher No. Warrant No.
362749 Miller, Kelsey Allowed 20
In Sum of$
91.30
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #[TITLE AMOUNT Board Members
Dept
1081 -5 Reimb. 4343000 91.30 I 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
22 -Apr 2010
Signature
91.30 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund