192249 11/23/2010 CITY OF CARMEL, INDIANA VENDOR: 364715 Page 1 of 1
ONE CIVIC SQUARE DENEYSE SOLAZZO
CARMEL, INDIANA 46032 14151 PEPIN PLACE CHECK AMOUNT: $65.00
CARMEL IN 46032
o CHECK NUMBER: 192249
CHECK DATE: 11123/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 65.00 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 181 (1988)
MILEAGE CLAIM l
TO 1 h11J.AS.� SG �[�ZrZ�
GOVERNMENTAL UNIT?
ON ACCOUNT OF APPROPRIATION NO- FOR
(OFFICE, BOARD, PEFARTIONT OR IWST=ION)
SPEEDOMETER
DATE FR TO READING t NATURE OF BUSINESS FILES tllLF� E r
r--�� POINT POINT START FINISH TRAVELED P WLE
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to IS i 41 KC-C.
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AUTO LICENSE NO- TOTALS I �U M. IC
5 cc)
f 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 aliowing ail just credits
end that no part of the same has been paid.
Date
L y
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.
364715 Solazzo, Deneyse Terms
14151 Pepin PI
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
11/12110 Reimb Mileage 10/1 11/12/10 65.00
Total 65.00
1 hereby certify that the attached invoice(s), or bills) 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.
364715 Solazzo, Deneyse Allowed 20
14151 Pepin PI
Carmel, IN 46032
In Sum of
65.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -9 Reimb 4343000 65.00 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
18 -Nov 2010
Signature
65.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund