189568 08/31/2010 CITY OF CARMEL, INDIANA VENDOR: 364666 Page 1 of 1
ONE CIVIC SQUARE BRADLEY WORRELL
0 CHECK AMOUNT: $63.15
CARMEL, INDIANA 46032 12550 SCOTTISH BEND
CARMEL IN 46033 CHECK NUMBER: 189568
CHECK DATE: 8/3112010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1160 4343004 63.15 TRAVEL PER DIEMS
PRESCRIBED BY STATE BOARD OF ACCOUNTS r GENERAL FORM NO- 101 (198
MILEAGE CLAIM
✓r��� To Ca ✓ale I Te d
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
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(OF CE, BOARD, DEPARTMENT OR INSTITUTION)
DATE FROM TO PEEDOM T +R AUTO MILEAGE
NATURE OF BUSINESS MILES m
POINT POINT START FINISH TRAVELED PER MILE
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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 all wing all just credits y G,
and that no part of the same has been paid. a l
Date
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.
correct
That it is apparently incorrect
Disbursing Officer
On Account of Appropriation No. for
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A.E. BOYCE CO., INC. MUNCIE, BV 01136 (D
VOUCHER NO, WARRANT NO.
ALLOWED 20
Brad Worrell
IN SUM OF
12550 Scottish Bend
Carmel, IN 46032
ON ACCOUNT OF APPROPRIATION FOR
Mayor's Office
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1160 Milege claim 43- 430.04 $4;29R I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
tom' materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, August 30, 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))
08/20/10 Milege claim $126.30
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