191817 11/10/2010 CITY OF CARMEL, INDIANA VENDOR: 364657 Page 1 of 1
ONE CIVIC SQUARE JESSICA RICHARDS CHECK AMOUNT: $39.00
CARMEL, INDIANA 46032 1832 N GLENDORA DR
INDPLS IN 46214 CHECK NUMBER: 191817
CHECK DATE: 11/10/2010
DEPARTMENT ACCOU PO NUMBER INVOICE NUMB AMOUNT DESCRIPTION
1081 4343000 REIMB 39.00 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD Or ACCOUNTS GEItFAA1 FORM 140. 101 (ISM$)
MILEAGE CLAIM
1GOVIANMENTAL MITI 11 tIO JY I
ON ACCOUNT OF APPROPRIATION NO- FO
(OF BOARD, DFPAATI@fT OR INSTITUTION)
SPEEDOMETER
DATE FROM TO I BEADING NATURE OF BUSINESS MI ES �E
z PO POINT START FINISH 1
TAA\I£LED PER MILE
D
G
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d mar.,,
4 Mom, 3
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AUTO LICENSE NO 1
TOTALS
SPEEDOMETER HEADING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
t
Pursuanl to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing account is just and correct, that the amount clai is legally due, aft aliowin all just credits
and that no r p of t e same has been paid,
Date Vl 0
A0 .10
uc 2 n z ol Li
l�v
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.
364657 Richards, Jessica Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
10117110 Reimb Mileage 9/9 10/12/10 39.00
Total 39.00
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
364657 Richards, Jessica Allowed 20
In Sum of
ti 39.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -4 Reimb 4343000 39.00 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
39.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund