187307 07/07/2010 ^�F CITY OF CARMEL, INDIANA VENDOR: 355994 Page 1 of 1
t ONE CIVIC SQUARE PAMELA GRIFFITHS CHECK AMOUNT: $76.60
CARMEL, INDIANA 46032 12906 DOUBLE EAGLE DRIVE
CARMEL IN 46033 CHECK NUMBER: 187307
CHECK DATE: 7/7/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AM DESCRIPTION
1202 4343002 012910 -03101 27.00 MILEAGE
1207 4343002 121409 -01271 49.60 MILEAGE
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PRESCRIBED GENERAL FORM NO. 101 (1986) ED BY STATE BOARD OF ACCOUNTS I
_r MILEAGE CLAIM
TO
(GOVER ENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
;PEEDOMETEA AUTO MILEAGE
DATE FROM TO TREADING NATURE OF BUSINESS
19 POINT POINT START FINISH TRAVELED PER MILE
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AUTO LICENSE O. OTALS
1
SPEEDOMETER READING columns are to be used only when distance between points canno e det r mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, 1 hereby certify that the I go "ougis ju d correct, that the amount claimed is legal e, after allowing all just credits
and tlia o part of the same has been paid. rr
Date JUL 02 2010
By
CaimNo Warrant No. I have examined ±&wthia /6madbemb
IN FAVOR OF cemfia fe6_E
That it B in proper form.
That ia duly authenticated as required
by law.
That ab based u statutory authority
Ihlab apparently ƒincorrect Rre
Account
Disbursing Officer OnAc
Appropriation No .-for
o W a
\k�
n
y
7 2 j
Allowed 1g�
in the sum of
G U 0
(B_a mCommission) 2N M
FILED t 7
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to
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'u.BOY CO,, ENC IN 01136 k n K
1
GENERAL FORM NO. 101 (1986)
PRESCRIBED BY STATE BOARD OF ACCOUNTS
MILEAGE CLAIM l 5
TO-
(GO N AL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR IIISTrMION)
SPEEDOMETER AUTO MILEAGE
DATE FROM TO READING MILES
NATURE OF BUSINESS TRAVELED
19 POINT POINT START FINISH PER MILE
24 to C' L l eTU 1 CI
v C i V- C Fi cI, I"? �l 3 I s'r r �sJ I! C 3 G' °7
Co to L, 3 4 r c
3' V Je Z r L iA -C A LL
r al l
n Srt r�L j n)r �u;nh�i 4� i�16(
3j G C. C LL �f.L H i3,. s� 0 AT4 a
10 v i G 4 A -C C. C C CDr r S� �k
'r AV E o ai2' CIVrc: Ci4ILL 1
V 0
r �}e C r v' C lAU:- I
3 1 15 C- i t- 04 i W e: L" E EEiaE 7t7' C' u P IDA 7
l' G N Ar C1i)(, L ti u
1 0 11 6Qi l t o tn' cc viz
6 .4-v 3
AUTO LICENSE NO. TOTALS 7 JO
SPEEDOMETER READING columns are to be used only when distance between points Cann e d9�l'ined�v f' mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that thf egoiin is and correct, that the amount claimed is legal ue, after allowing all just credits
and tlia o part of the same has been paid.
J UL �i 2 20W
Date
By
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form.
That it is duly authenticated as required
by law
That it is based upon statutory authority.
That it is apparently correct
incorrect
Disbursing Officer
On Account of Appropriation No. for
o tor w
R- w a.
a
0 n
W
0 r"
t
m p n
Allowed 19� 0 P
o kr 0
co
in the sum of m
U Q:
w M
b a
CD m
m ti m
p n
P-
P. n
O
n '4
(Board or Commission)
tD
p p P
c EL
FILED
a CD
a
a
Vl
(Official Title) o o
e
C N
A.E. BOYCE CO., INC. MUNCQ, IN 01136 Q A
i
VOUCHER NO. WARRANT NO,
ALLOWED 20
Parn Griffiths
IN SUM OF
$76.6
ON ACCOUNT OF APPROPRIATION FOR
Carmel IS Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1202 121409- 012710 43- 430.02 $49.60 1 hereby certify that the attached invoice(s), or
1202 012910 031110 43- 430.02 $27.00 bifl(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Thursday, July 01, 2010
ire tor,,
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995;
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or 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.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill
06/23/10 121409- 012710 $49.60
06/29/10 012910 031110 $27.00
I 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
1 20
Clerk- Treasurer