190459 09/29/2010 CITY OF CARMEL, INDIANA VENDOR: 364763 Page 1 of 1
ONE CIVIC SQUARE MONICA SEGAR
CHECK AMOUNT: $19.75
CARMEL, INDIANA 46032 7904 STONEBRANCH N DR
INDPLS IN 46256 CHECK NUMBER: 190459
CHECK DATE: 9/29/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343000 19.75 TRAVEL FEES EXPENSE
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PRRSCRISED BY STATE BOARD OF ACCOUNTS M4FAAL FORM NO- IQI (INS]
MILEAGE CLAIM M 1
tOOVTRNNENTAL UNIn
ON ACCOUNT OF APPROPRIATION NQ. FO f
(OF BOARD, DEPARTMENT OR I N SMWIOtO
SPEEDOMETER 4
V FROM TO BEADING t NATURE OF BUSINESS t A MILES C9
POINT POINT START FINISH TRAVELED PER MILE
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1 I _I
t 1 UI t PIC
0 1 Ek 111'S
T U
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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.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foTegocng account is just and correct, that the amount claimed is legally due, after allowing all just credits
end that o part of t he same has been paid. t
Date ����ST
IT
1
�0
5 2010
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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,
Segar, Monica Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
8128110 Reimb Mileage 19.75
Total 19.75
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
Voucher No. Warrant No.
Segar, Monica Allowed 20
In Sum of
19.75
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1082 -1 Reimb 4343000 19.75 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
23 -Sep 2010
Signature
19.75 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund