186365 06/09/2010 CITY OF CARMEL, INDIANA VENDOR: 361054 Page 1 of 1
ONE CIVIC SQUARE CHARLES A IMAN
i CHECK AMOUNT: $49.00
CARMEL, INDIANA 46032 11018 TAM 0 SHANTER DR
o o. CARMEL IN 46032 CHECK NUMBER: 186365
CHECK DATE: 6/912010
DEPARTMENT ACCOUNT PO NUMBER INV NUMBER AMOUNT DESCRIPTION
1081 4343000 49.00 TRAVEL FEES EXPENSE
,i
PRESCRIBED BY STATE BOARD OF ACCOUNTS MILEAGE CLAIM GENFRAL FORM HQ. 10) ONO
V
TO
L/ C•� (GOVM „EN UNIT)
ON ACCOUNT OF APPROPRIATION NQ FOR
t0"Cy, BOARD. DEEARTUENT OR INSr0VTJO8)
SPEEDOMETER
DATE
FROM TO READING AUTO MILEAGE
NATURE OF BUSINESS WLES (Y s
POINT POINT START FINISH TRAVELED PER MILE
f
6, ro
�1 r
f
,t f
(Q f I
3 ho n
r
Y
AUTO LICENSE NO. TOTALS V
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing account is just and correct, that the.amount claimed q 11 a HOW g all just credits
and that no part of the s me has been paid.
i
Date
1 JUN 0 1
'r a a..o...o,
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; hour, d of service, units.. price performe
unit dates service rendered, by
whom, rates per day, number of hours, rate per
Payee Purchase Order No.
Terms
361054 Iman, Charles Date Due
Invoice
Invoice Description PO Amount
Date Number (or note attached invoice(s) or bill(s)) 49.00
5127110 Reimb Milea a 514 5!27110
Total 49.00
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and 1 have audited same in accordance
with IC 5- 11- 10 -1.6
20_
Clerk- Treasurer
Voucher No. Warrant No.
Iman, Charles Allowed 20
361054
In Sum of$
49.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT#fTITLE AMOUNT Board Members
Dept
1081 -3 Reimb 4343000 49.00 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
3 -Jun 2010
Signature
49.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund