192017 11/23/2010 CITY OF CARMEL, INDIANA VENDOR: 360144 Page 1 of 1
ONE CIVIC SQUARE CYNTHIA CANADA CHECK AMOUNT: $149.00
CARMEL, INDIANA 46032 11508 LUCKY DAN DRIVE
NOBLESVILLE IN 46060 CHECK NUMBER: 192017
QOM
CHECK DATE: 11/23/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 149.00 TRAVEL FEES EXPENSE
P"-SCRIBED HT STATE BOARD Or ACCOUNTS GEHF.PAL FORM PO. 101119661
MILEAGE CLAIM f
ro
(GOVEMMENTAL 171411) ON ACCOUNT OF APPROPRIATION NO. FOR
toF< C$, BoAYW 6EPAAn4xRT oR 1NST nrnow7
FROM TO SPEEDOMETER AUTO NILE$GE
DATE I READING v
NATURE OF BUSINESS
POINT POINT START FINISH TRAVELED
ED r
PER MILE
e eLA-�
o Sfi
5
C- 'e
G sL_
S t
i fl' C-
r.
fN�
r
IPQA
W I
1
nD
tan 0_
1
iNti T t'1
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_ 1
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 aliowing all just credits
end that n� part o t he same has been paid.
Date __T__� ��°p{
PRESCRIBED HT STATE BOARD OF ACCOUNTS GENERAL FORM Ii G. Le] 11"s)
MILEAGE CL
C-� I
ro_ �._s Cl
(GOVERNMENTAL (FNITI
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD DEPARTMENT OR INSTTTUTION)
FROM TO SPEEpOMETER AUTO 1• MADE
DATE READING
MILES
POINT POINT SCAR7 FINISH NATURE OF BUSINESS TRAVEEI] r• L
PER MILE
1
9 1' �D Z' J&o 5, 4-e 3i
I -S
IND M T IYt
Cti
MQ 6nJ C
1
C
3: Ll
1 0 E LW CYI z (vo vte
�'1 f� f
AUTO LICENSE NO. TOTALS
U/
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 Raxt of 14e same has been paid-
Date 1 1� 1 Cme
-c� q
,S fl4q f�
J
PRPSCMED BY STATE BOARD OF ACCOUNTS GENKNAL FOAL RC. 101 (1486)
MILEAGE CLAIM f N C 1,
5
(GOVERNMENTAL UNIT) D
ON ACCOUNT OF APPROPRIATION ND. FOR
(O"CE, BOARD, 1)EPAA7Y3M OR 1NSr rvr10N)
FROM TO SPEEDOMETER AUTO un v E
DATE READING f
2 a POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MILE
V f-
r
�J
kik no
A
DK1 n
m� k
o nn i
ti r n
f
VIC, o
AUTO LICENSE NO- TOTALS O
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map QQQJJJ
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 aliowing all just credits
end that no part of the same has been paid
Date i I S I F)
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.
360144 Canada, Cyndi Terms
11508 Lucky Dan Dr
Noblesville, IN 46060
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
11/15/10 Reimb. Mileage 8123 11/15/10 149.00
Total 149.00
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.
360144 Canada, Cyndi Allowed 20
11508 Lucky Dan Dr
Noblesville, IN 46060
In Sum of$
149.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -5 Reimb. 4343000 149.00 I 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
18 -Nov 2010
Signature
149.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund