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191548 11/10/2010 CITY OF CARMEL, INDIANA VENDOR: 364750 Page 1 of 1 ONE CIVIC SQUARE JESSICA BALLINGER CARMEL, INDIANA 46032 10830 TOOLEY CT CHECK AMOUNT: $104.00 APT IF CHECK NUMBER: 191548 INDIANAPOLIS IN 46234 CHECK DATE: 11/10/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4343000 104.00 TRAVEL FEES EXPENSE PRrSCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 10) (ME) MILEAGE CLA (GOVERNMENrAL UNI'11 �J lit ON ACCOUNT OF APPROPRIATION NO. FOR (OF?ICK, BOAAU, DEPARTMF3f7 OR INSTRU'r10X) SPEEDOMETER DATE FROM TO READING NATURE OF BUSINESS Mn SC) C Y r Z° POINT POINT START FINISH TRAVELED PER MILE 5 el f I t 5c t 3 Se a 00 L 4- 1 S 9 im o g f iZ Mt✓ty ;n ©C '1 O O ocl c3 oo J -1 fJC MCC c C. MCC oC MCC ca a ct cv CC 4 mL MCC Z ai� ref' ZO r VIA n AUTO LICENSE NO_ TOTALS f n O CEO 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 due, after allowing all just credits and that no part of the same has been paid. :Date C n: 7- f 1 0 1 0 V L/ y3 r o 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. 364750 Ballinger, Jessica Terms Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 10/25/10 Reimb Mileage 9/15 10/25/10 104.00 Total 104.00 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. 364750 Ballinger, Jessica Allowed 20 In Sum of 104.00 ON ACCOUNT OF APPROPRIATION FOR 108 ESE PO# or INVOICE NO. ACCT #rTITLE AMOUNT Board Members Dept 1081 -10 Reimb 4343000 104.00 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 4 -Nov 2010 Signature 104.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund