189442 08/31/2010 CITY OF CARMEL, INDIANA VENDOR: 361086 Page 1 of 1
ONE CIVIC SQUARE JACOB C MOORE
CHECK AMOUNT: $63.75
CARMEL, INDIANA 46032 348ATHERTON DR
CARMEL IN 46032 CHECK NUMBER: 189442
CHECK DATE: 8/3112010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343000 63.75 TRAVEL FEES EXPENSE
i
1
PRESCRIBLD BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. IDI {19867
MILEAGE CLAIM
I
TO
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR'
IOFiiCE, BOARD, DUARTWEXT OR INST=10N7
$PEEDOMETEA
DATE FROM TO I Y READING AUTO Q 0AGE
Zo ,1 NATURE OF BUSINESS
POINT POINT START FINISH TRAVELED PER MILE
vv�e- C en
Wte t° O
s vie 15 C M CC- a Y
v+^e 7 G1. cc_
L 2 I? C cc
un e U I C 14
Zvi 2 -R d b cwt ex W
C! eK u sf=r
X/ tv Z C! aj is Ck;f�. l+ YJ iA 'ci, Cl P�tvr• 1/ttcLte s lCsK 1
v 12
Il u(
s t Z cr
cc IA
?L/ 2 C /lt C. AC« r- r
v L C C_ C. l-
i! 2 rr E ew, I 'K 3 0
Awd L El G.
�L C.�f L
/v1 C
C C_ I Y of .h.f Ce_ r. i u
AUTO LICENSE NO. 4 i TOTALS t 2 fr ifj 3 7 5
s*
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
end that no part of the same has been paid.
r-2-
Date
16 2010
r.
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.
361086 Moore, Jacob Terms
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s)) PO
8112/10 Reimb. Mileage 611 8/10!10
63.75
Total 63.75
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
20,
Clerk Treasurer
Voucher No. Warrant No.
361086 Moore, Jacob Allowed 20
In Sum of
63.75
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1082 -1 Reimb. 4343000 63.75 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
Signature
63.75 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund