188836 08/18/2010 CITY OF CARMEL, INDIANA VENDOR: 00350224 Page 1 of 1
J f ONE CIVIC SQUARE NANCY HECK
CARMEL, INDIANA 46032 CHECK AMOUNT: $138.25
CHECK NUMBER: 188836
CHECK DATE: 8/18/2010
D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1160 4343004 MILEAGE 138.25 TRAVEL PER DIEMS
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORM NO. 101- (1986)
MILEAGE CLAIM Peck f 3 a• ZOO T�
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
DATE FROM TO S READ M T R AUTO MILEAGE
MILES
'Y— 9 ablo POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MILE
(7 o of 1 uJK I
a 301 L 1 A. I/Yi r S pK
3 016 r 1 ��MM ,�,e 4g; n f' -1ji.e %vi t d e �l 7
st I' A cl OMG alr vn fct4 /G �Ah�(p er
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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, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing all just credits
and that art of the same has been paid.
bate LW& �L
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
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in the sum of
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(Board or Commission) Q. M rt
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A. E. BOYCE CO., INC. MUNCIE, IN aIJ36 f1 a.
VOUCHER NO. WARRANT NO,
Nancy Heck ALLOWED 20
IN SUM OF
1326 Cool Creek Drive
Carmel, IN 46033
$138.25
ON ACCOUNT OF APPROPRIATION FOR
Mayor's Office
PO# Dept. INVOICE NO, ACCT #!TITLE AMOUNT Board Members
1160 Mileage Claim 43- 430.04 $138.25 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
Friday, August 13, 2010
Mayor
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(s))
08/10/10 Mileage Claim $138.25
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
1 20
Clerk- Treasurer