190366 09/29/2010 CITY OF CARMEL, INDIANA VENDOR: 364002 Page 1 of 1
b ONE CIVIC SQUARE ASHLEY LIVINGSTON CHECK AMOUNT: $126.00
CARMEL, INDIANA 46032 3404 WOODFRONT PLACE
`o. INDIANAPOLIS IN 46222 CHECK NUMBER: 190366
CHECK DATE: 912912010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 126.00 TRAVEL FEES EXPENSE
PMCFIIBED BY STATE BOARD OF ACCOUNTS OENFAAL FORM NO. IOI tInO
MILEAGE CLAIM
[�GOV0 N]IENTAL UNIT) ACCOUNT OF APPROPRIATION O- R
lOii[CB, BCTARD, DEPAATYElfI OR INSYCf[fTlO![)
SPEED014FTER
DATE FROM To READING NATURE OF BUSINESS A MILES 0 D E f
POINT POINT START FINISH TRAVELED PER MILE
2 c�Y C
n
f 1n
7 t
a 3 nt
4 7
Z iii m
r
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 1453, I hereby certify that the foTegoing account i9 just and correcl, that the amount claimed is legally due, after allowing all just credits r
and that no part of the same has been paid.
Date
1
8
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.
Terms
364002 Livingston, Ashley
Invoice Invoice Description PO Amount
Date Number (or note attached invoice(s) or bill(s))
126.00
9110110 Reimb Mileage 812 9110/10
Total 126.00
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.
364002 Livingston, Ashley Allowed 20
In Sum of
126.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #ITITLF AMOUNT Board Members
Dept
1081 -2 Reimb 4343000 126.00 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
&L M jo
Signature
126.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund