190784 10/13/2010 CITY OF CARMEL, INDIANA VENDOR: 358411 Page 1 of 1
ONE CIVIC SQUARE JENNIFER HAMMONS CHECK AMOUNT: $280.50
CARMEL, INDIANA 46032 634 NORTHVIEW AVENUE
INDIANAPOLIS IN 46220 CHECK NUMBER: 190784
CHECK DATE: 10/13/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 280.50 TRAVEL FEES EXPENSE
GENERAL FORK Ito, 103 119861
PBFSCRIam BY STATE BOARD OF ACOOUN15
MILEAGE CLAIM CJelrlt'� L rn Xe �fG C�
TO �(�`ry
tGOVERNNENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OMCY, BOARD, DEPARTHI;14F OR IN9=10N)
SPEEDOMETER AUTO MILEAGE
NATURE OF BUSINESS TRAVELE DATE FROM TO READING MILES till
POINT POINT START FINISH 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. TV -rA L
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 dUa, after aliowin all just dits
and that no part of the s me has been paid.
Date IC
StN002010
BY:
PPMCRIBED BY STATE HOARD OF ACCOUNTS GENERAL FORM tic_ 161 (19661
MILEAGE CLAIM �en Ip� mYY1�S
ro
(GOVERNMENTAL UNn'1
ON ACCOUNT OF APPROPRIATION NO. FOR
(OHICE, BOARD, DEPARTMENT OR INSnTUrION)
FROM TO T §PEEDOMETER AUTO 11il.EAGE
DATE READING
ES
POINT POINT START FINISH NATURE OF BUSINESS TRAVE ED r
PER MILE
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CC M e--
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Sill A (>g. r— r
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3. f.'7
AUTO LICENSE NO. TOTALS 0 j
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 du after all ing ll just a is.-
and that no part of th same has been paid.
Bate
rr-a
sCP 0 200
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.
Terms
358411 Hammons, .Jennifer
634 Northview Ave Date Due
Indianapolis, IN 46220
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s))
PO Amount
9/29110 Reimb. M +lea e 514 9130110 280.50
Total j 280.50
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.
358411 Hammons, Jennifer Allowed 20
634 Northview Ave
Indianapolis, IN 46220
In Sum of
280.50
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -10 Reimb. 4343000 280.50 1 hereby certify that the attached invcice(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
7 -Oct 2010
Y
Signature
280.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund