189266 08/31/2010 CITY OF CARMEL, INDIANA VENDOR: 364278 Page 1 of 1
ONE CIVIC SQUARE PATRICK BURTCH CHECK AMOUNT: $23.75
CARMEL, INDIANA 46032 11854 ASHTON DR
FISHERS IN 46038 CHECK NUMBER: 189266
CHECK DATE: 8/31/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343000 REIMB 23.75 TRAVEL FEES EXPENSE
PRESCRIBED HT STATE e0A0.p OF ACCOUN75 GENERAL FORM No. 101 11M
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MILEAGE GLA�M Dz-t'rl
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE. HOARD, DEBART6M(T OR iNsTTTVriox)
SPI�DOMET£R AUTO MILEAG.
D FROM To READING NATURE OF BUSINFS6 MILES j•J
POINT POINT START FINISH 1-RAVELX13 PER MILE
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AUTO LICENSE NO.�
TOTALS '7
SPEEDOMETER HEADING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway. map. 2 7•��
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 legall, o er V14 just credits,-
and that no pa o f f th same has been paid,
Date —T�
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.
364278 Burtch, Patrick Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
7129110 Reimb Mileage 7/13 7/21/10 23.75
Total 23.75
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.
3642.78 Burtch, Patrick Allowed 20
In Sum of
23.75
I
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1082 -1 Reimb 4343000 23.75 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
26 -Aug 2010
�Q&jk b
Signature
23.75 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund