192092 11/23/2010 CITY OF CARMEL, INDIANA VENDOR: 358411 Page 1 of 7
0 ONE CIVIC SQUARE JENNIFER HAMMONS
CARMEL, INDIANA 46032 634 NORTHVIEW AVENUE CHECK AMOUNT: $386.50
INDIANAPOLIS IN 46220
CHECK NUMBER: 142092
CHECK DATE: 11/2312010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMS 386.50 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENFRAI. FORM Ho. 10) (1985)
MILEAGE CLAIM eno i��
To `J 1 j
{GOVERNMENTAL Uxt'n T
ON ACCOUNT OF APPROPRIATION NO- FOR
tOE?ICP, BonRO, orrARTMxxi OA ]NS[rnfIlox)
SPEEDOMETER
DATE FROM TO I READING AUTO MILEAGE
NATURE OF BUSINESS MIL ED
c POINT POINT START FINISH PER MILE
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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, 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 i o
TO 17, 5 N3
j 7 201
BY:
PRESCRIBED By STATE BOARD OF ACCOUNTS GENERAL FORM NO. 10) (1986)
MILEAGE CLAIM
(GOVERNMENTAL UNITE ON ACCOUNT OF APPROPRIATION NO- FOR
(OFFICE, BOARD, DEPARTMEfF OR )NS'TITUnON)
r SPEEDOMETER
'nDF+,,TE FROM TO I READING AUTO SAGE
NATURE OF HUSINESS MILES Q+ t
POINT POINT START FINISH 1'AAVELSD PER MILE
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c. v\1 C-
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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, I 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 the a h s been paid.
Date 1 1 d
q F
NOV I in l i t *f
PRUCRISED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 119867
P I N
MILEAGE CLAIM
ro
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFiICE• BOARD. DEF&RTMF(r OR INSnYUIION)
FROM TO it ER MILEAGE SPEEDOMET
DATE I T READING AUTO
POINT POINT START FINISH NATURE OF EUSINESS T 1EL C� 'zoo
PER MILE
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7 as aQ
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AUTO LICENSE NO. TOTALS w
SPEEDOMETER READING columns are to be used only when distance between paints 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, aiter allow' q all credits
end that no part of the same has been paid. O
Date to IS'- (Q
01 C� got 1
V z 72010 All
BY
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.
358411 Hammons, Jennifer Terms
634 Northview Ave Date Due
Indianapolis, IN 46220
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
11/15/10 Reimb. Mileage 6114 10/12/10 386.50
Total 386.50
f 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
i
Voucher No. Warrant No.
358411 Hammons, Jennifer Allowed 20
634 Northview Ave
Indianapolis, IN 46220
In Sum of
386.50
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -10 Reimb. 4343000 386.50 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
18 -Nov 2010
Signature
386.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund