189827 09/14/2010 CITY OF CARMEL, INDIANA VENDOR: 360926 Page 1 of 1
ONE CIVIC SQUARE SHAVONNE HOLTON CHECK AMOUNT: $68.50
CARMEL, INDIANA 46032 3707 N MERIDIAN ST APT 3B
INDIANAPOLIS IN 46208 CHECK NUMBER: 189827
CHECK DATE: 911412010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343000 68.50 'TRAVEL FEES EXPENSE
GENERAL FoRld I'C' 161 117661
PRESCRIBED BY STATE BOARD OF ACCOUNTS
MILEAGE CLAIM r
TO y �1
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFaCE, BOARD. DEPARTMENT OR INSYnWION)
FROM TO §G FR O MILEAGE C
SAD IA READIN
TTE NATURE OF BUSINESS MIL
POINT POINT START FINISH TRAVELED PER MILE
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AUTO LICENSE NO. TOTALS 3� '0% 50
i3PEEDOMETER 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 i gaEl due, r liowinq all just credits
and that no.p Dame has been paid.
Date
1010
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 Order No.
360926 Holton, Shavonne Terms
8001 Canary Ln Apt A Date Due
Indianapolis, IN 46260
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
8126110 Reimb. Mileage 712 7130110 68.50
Total 68.50
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
i
Voucher No. Warrant No.
360926 Holton, Shavonne Allowed 20
8001 Canary Ln Apt A
Indianapolis, IN 46260
In Sum of
68.50
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #fTITLE AMOUNT Board Members
Dept
1082 -5 Reimb. 4343000 68.50 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
9 -Sep 2010
P&b k l n�
Signature
68.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund