191364 10/27/2010 CITY OF CARMEL, INDIANA VENDOR: 364715 Page 1 of 1
ONE CIVIC SQUARE DENEYSE SOLA7Z0
a CARMEL, INDIANA 46032 14151 PERIN PLACE CHECK AMOUNT: $55.00
CARMEL IN 46032 CHECK NUMBER: 191364
CHECK DATE: 1012712010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 55.00 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENFAAL FORM NO- 101 (1906)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO- FOR
(OFFICE, BOARD, DEFARTMEMr OR 1NST=108)
SPBEDOMETFR
DATE FROM TO I READING A 85 c
NATUAE OF BUSINESS
POINT POINT START FINISH TRAVELED PER
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AUTO LICENSE NO- TOTALS I lD cy
1�
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, 1 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 t e same has been paid.
Date tC�
1. r 2010
BY:
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMFL
An invoice of bilk 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.
364715 Solazzo, Deneyse Terms
14151 Pepin PI
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1014110 Reimb Mileage 911 9130110 55.00
Total 55.00
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,
364715 Solazzo, Deneyse Allowed 20
14151 Pepin PI
Carmel, IN 46032
In Sum of
55.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #fTITLE AMOUNT Board Members
Dept
1081 -9 Reimb 4343000 55.00 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
21 -Oct 2010
Signature
55.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund