189692 09/14/2010 CITY OF CARMEL, INDIANA VENDOR: 364681 Page 1 of 1
ONE CIVIC SQUARE TRACEY BLOOMFIELD CHECK AMOUNT: $20.00
CARMEL, INDIANA 46032 9616 FRONTIER ST
FISHERS IN 46038 CHECK NUMBER: 189692
CHECK DATE: 9/14/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 20.00 TRAVEL FEES EXPENSE
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PRLSCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORA NO. 181 (19861
MILEAGE CLAIM
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(GOVERNMENTAL UNIT}
F ON ACCOUNT OF APkJRJATION NO. FOR
(OFFICE BOARD, DEPARTMENT OR INSTErVIION)
FROM TO SPEEDOMETER AUTO M11L
DATE I READING NATURE OF BUSINESS Mms C) t
2-8 POINT i POINT START FINISH o TRAVELED PER MILE
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AUTO LICENSE NO. f TOTALS 1c V�
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 aliowing all just credits
end that no part of the same has been paid.
Date 0
a (M 05
A 2 5 2010
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PUSCRIBED BY STATE BOARD OF ACCOUNTS CENFAAL FORM I +G. 101 11986)
yy MILEAGE CLAIM
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1(TQ1FANM VITAL UNBTI ON ACCOUNT OF APP OPRIATION NO. FOR
,mat, BOARD, DEPARTQ]fr OR IN4nTUrlON)
REA13 SPEEDOM
AUTO Z E
2 DAB FROM TO
O —1. NATURE OF BUSINESS MILES C
POINF POINT START FINISH TRAVELED
C rF n)
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I
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 loregoing account is just and correct, that the amount claimed is legally du after allowing all just credits
end that no pail of the same has been paid.
Bate
�4 SFP 0 1 2010
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.
Bloomfield, Tracey Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
8]20110 Mileage 812 8.00
813110 12.00
Reimb
8125!10 Reimb Mileage 8123 812511 0
Total 20.00
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.
Bloomfield, Tracey Allowed 20
x
In Sum of
20.00
I ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #rFITLE AMOUNT Board Members
Dept
1081 -2 Reimb 4343000 12.00 1 hereby certify that the attached invoice(s), or
1081 -2 Reimb 4343000 8.00 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
9 -Sep 2010
Signature
20.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund