189708 09/14/2010 CITY OF CARMEL, INDIANA VENDOR: 360144 Page 1 of 1
0 3i ONE CIVIC SQUARE CYNTHIA CANADA
CARMEL, INDIANA 46032 11508 LUCKY DAN DRIVE CHECK AMOUNT: $78.75
NOBLESVILLE IN 46060 CHECK NUMBER: 189708
CHECK DATE: 9/14/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 78.75 TRAVEL FEES EXPENSE
,ti
PRLSCRIBED BY STATE BOARD OF ACCOUNTS GENFAAL FORT! 110, 10) (INS)
MILEAGE CLAIM f
TO -10 C i•
(GOVERNMENTAL MY)
ON ACCOUNT OF APPROPRIATION NO. FOR
tOF 1 fC BOARD, DE}ARTMEWT OB INSMTUIIONI
SPEEDOMETER
FROM TO AUTO MILEAGE
DATE READING
POINT POINT START FINiSIi NATURE OF BUSINESS TRAVELED
PER MILE
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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. VV
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.
Date
O�
SEA 0 1
200
BY:
PR73CftI8CD BY STATE HOARD OF ACCOUNTS
GENFRAL FORM NO. 101 (198H)
MILEAGE CLAIM C sj 1� 1'
SO C9 L
1GOVERNMENTAL UNIT} ON ACCOUNT OF APPROPRIATION NO. FOR
[OFFICE, BOARD, DEFAR'T),W" OA INSTTTUTION)
SPEEDOMETER
DATE FROM TO E READING MMES a MILEAGE t
NATURE OF BUSINESS
POINT POINT START FINTSH TRAVELED PER MILE
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2- Car—
no
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F;
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v
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rtia -t 3
AUTO LICENSE NO. TOTALS
SPEEDOMETER READING columns are to be used only when distance between points cannot he determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after aliowing all just credits
and that no part of the same has been paid.
Date V
a� 1 W
f S E P 0 1 2010 r-
BY:
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 Oder No,
360144 Canada, Cyndi Terms
11508 Lucky Dan Dr
Noblesville, IN 46060
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
8131110 Reimb. Mileage 7/12 8119110
78.75
Total 78.75
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"
360144 Canada, Cyndi Allowed 20
11508 Lucky Dan Dr
Noblesville, IN 46060
In Sum of
78.75
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -5 Reimb. 4343000 78.75 1 hereby certify that the attached invoice(s), or
bills) 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
78.75 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund