189345 08/31/2010 CITY OF CARMEL, INDIANA VENDOR: 355994 Page 1 of 1
ONE CIVIC SQUARE PAMELA GRIFFITHS CHECK AMOUNT: $44.00
CARMEL, INDIANA 46032 12906 DOUBLE EAGLE DRIVE
CARMEL IN 46033 CHECK NUMBER: 189345
CHECK DATE: 8/31/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1202 4343002 040510 -05061 44.00 EXTERNAL TRAINING TRA
Prescribed by State Board of Accounts General Form No. 101 (1955)
MILEAGE CLAIM
IV
TO L r DR.
7
(Governmental Unit
On Account of Appropriation No. for
(Office, Board, Department or Institution)
DATE FROM TO ODOMETER READING` NATURE OF BUSINESS AUTO MILES MILEAGE
20 Point Point Start Finish TRAVELED PER MILE
L41 c� ,0 -G G -31 hr t✓ N R o o e
to C CGC.- hr C i
`v G -3 3 c4- c G hr 't a 5t U
crr 1 L 54 -I
44 4Yh d VI L L LA 14 1A ft I Q 1,6 -r LL -3qu -3q D 0 131•° VJQA, Ajf, D r a C
e it 10 1 i OI,E. D T Gt L S Gc
'r k i>� (fib t. -3 j u h J tM 1, uJ
i C44iA114 Q 1/1 C 6 C T
f r cS G LA, CvG>r
61/ '6aa;01- ,'64 klal 1, c h T h i
a c I
C cam 1 Do
U41 0 r o4' it
C'1/'e- aVjU 4 V o I m-15 W1 os oNe- (-eA H I
j CG i� va VV =1' a I' E
t W& L',U C 3 1 11L a ti L /ti QY4 6 Qk tz 69 4 k 1
Aa(, 40 C jSi i a i� r
V i t, L i
r, p
v i L J= t LL- 60 St' G 0 e d b4
o a Co L- a t 4-
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I rm, -G� L,- -"3 I� i i� V -fo LL
r I Or 1A I M ,G q e, LL, L dla ill
3 'on H a
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 Chapt er 155, Acts 1953, 1 hereby certify that and correct, that the amount claimed is I ally due, after
allowing all ju credits, and that no part of the same has been paid.
Date
Ao Qa�
J-D 0 AN 3 0 2010 C
Vr
By
Clcdm No. Wca-rctnt No. 1 have examined the within claim and
hereby certify as follows:
IN FAVOR OF
That it is in proper form;
That it is duly authenticated as required
by law;
That it is Lased upon statutory authority;
That it is apparently jcorrect
l incorrect
On Account of Appropriation No. for
Disbursing Officer
O
Allowed 20 o a,
H
in the sum of Q �2
o CD
N
CD
M
0
(Bond or Commission)
o. o
m
FILED ro 0
a m
o
R.
ro 6
n ro
Ln
Cn
m
(Official Title)
Cn O
I O
VOUCHER NO. WARRANT NO.
ALLOWED 20
Pam
IN SUM OF
$44.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel IS Department
PO# Dept. INVOICE NO. ACCT /TITL.E AMOUNT Board Members
1202 040510- 050610 43- 430.02 $44.00 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
Monday, August 30, 2010
Directo IS
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))
08/30/10 I 040510 050610 I $44.00
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