191730 11/10/2010 CITY OF CARMEL, INDIANA VENDOR: 364002 Page 1 of 1
ONE CIVIC SQUARE ASHLEY LIVINGSTON
i 1 0 I� CHECK AMOUNT: $74.50
CARMEL, INDIANA 46032 3404 WOODFRONT PLACE
INDIANAPOLIS IN 46222 CHECK NUMBER: 191730
CHECK DATE: 11/10/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 74.50 TRAVEL FEES EXPENSE
PALSCRISED BY STATE BOARD OF ACCOUNTS GEMFAAL FORM NG- 101 119061
MILEAGE CLAIM
TO
t 1�+ MEN7AL II'rl
ON ACCOUNT OF APPROPRIATION NO- F
(OFFICE, BOARD. DEPAATl fT OB ]NSrMfr1OA)
sPEEaaMETEx
DATE FROM TO READING AUTO f.no
2o- POINT POINT START FINISH NATURE OF BUSINESS MILES C� O
TRAVELED PER MILE
IF A 7 1
Z
�h
7
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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, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing all just credits
and that no part of the same has been paid.
Date
I 0 2010 [l
I
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.
364002 Livingston, Ashley Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
10/14/10 Reimb Mileage 9113 10/14/10 74.50
Total 74.50
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
Voucher No. Warrant No.
364002 Livingston, Ashley Allowed 20
In Sum of
74.50
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITL AMOUNT Board Members
Dept
1081 2 Reimb 4343000 74.50 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
4 -Nov 2010
Ax
Signature
74.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund