186757 06/23/2010 CITY OF CARMEL, INDIANA VENDOR: 364278 Page 1 of 1
ONE CIVIC SQUARE PATRICK BURTCH
CARMEL, INDIANA 46032
11854 ASHTON DR CHECK AMOUNT: $36.40
FISHERS IN 46038 CHECK NUMBER: 186757
CHECK DATE: 6/23/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 36.40 TRAVEL FEES EXPENSE
PRESCM&ED BY STATE HOARD OF ACCOUNTS GLNFAAL FORM A0.101 (18551
MILEAGE CLAIM Q
TO QGti�' I G� V U Cl'
(GOYEANMENTAL U111r7
ON ACCOUNT OF APPROPRIATION t10; FOR
(OFFICE, BOAEU DA lii9TLTV:IC}Nt-
SPEEDOMETEA
D A 1 L. FROM TO
READING AUTO MILEAGE
MATURE OF BUSINESS MILES 4
POINT. r POINT START FINISH TRAVELED
PER MILE
Irv`
.1 L t7A'n'
i
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US C_C I ra✓1�
riJ. rivoa
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AUTO LICENSE NO,
SPEEDOMETER READTNG columns are to be used only when distance between points cannot be determined by fixed mileage or, official highway map..
Pursuant to the provisions and penalties of Chapter ISS, Acts 1953, I heteby certify that the foregoing account is just and correct that the amount claimed is legall d e tnq'a ust credits
and that na p rt of The. same has been paid.
Date
7 1
JUN 0 4 2010
I�
I v Ey:
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Burtch, Patrick Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
612110 Reimb Mileage 513/10 5128110 36.40
Total 36.40
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20�
Clerk- Treasurer
Voucher No. Warrant No.
Burtch, Patrick Allowed 20
In Sum of$
36.40
,4
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE N0. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -4 Reimb 4343000 36.40 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
17 -Jun 2010
Signature
36.40 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund