192684 12/10/2010 CITY OF CARMEL, INDIANA VENDOR: 362749 Page 1 of 1
0 ONE CIVIC SQUARE KELSEY MILLER
CARMEL, INDIANA 46032 13259 EASTWOOD LN CHECK AMOUNT: $84.35
FISHERS IN 46038
CHECK NUMBER: 192684
CHECK DATE: 12/10/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 84.35 TRAVEL FEES EXPENSE
PMCRIl ED BY STATr BOARS] OF ACCOUNTS GENERAL FORM NO. 101 119867
MILEAGE CLAIM 6
ON ACCOUNT OF APPROPRIATION NO. FOR
(O r CE, BOARD. Dr3AAr UXr OR 1NarMYr10N7
SPEEDOMETER
DATE FROM TO READING AUTO MILEAGE c
NATURE OF HUSINES6 MILES
POINT POINT START FINISH TRAVTLED PEAS
i
Q'
Z
v
A mj f I
iA
I L4
7a 1 14
t
i
Z T 11 71
OR 6erD 1
AUTO LICENSE NO. TOTALS F O
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 QL.Ldits
end that no part �of the a as been paid.
Date 1_V o
,qgq
DEC 0 6 2010
JS
PRPSCRIB ED BY STATE BOARD OF ACCOUNTS GENF.BAL FORM 110, 191 11986)
MILEAGE CLAIM
so J(>
VERNI ENTAL UNIT)
ON ACCOUNT OF APPAOPAIAT N NO- FOR
(OFFICE, BOARD, DrYABT EHT OR TNSr=108)
DATE FROM TO EAD READING SPEEDOMETER AUTO MILEAGE
NATURE OF BUSINESS MILES
Zb POINT POINT START FINISH TRAVELED PER Ulu
i
i
L
%A r W-
Mzx s
1
i
Q 3
p l l b
fl7
0--
;D 100
f5
AUTO LICENSE NO. TOTALS 1 a 6 U 3p
111 6
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 a of tl sa a bas been paid. 6AtLWA'� Aa�
Date
7 f062010
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,
362749 Miller, Kelsey Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
12!3110 Reimb. Mileage 7/6 11/24/10 84.35
Total 84.35
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
.20
Clerk- Treasurer
Voucher No. Warrant No.
362749 Miller, Kelsey Allowed 20
In Sum of
84.35
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -5 Reimb. 4343000 84.35 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
9 -Dec 2010
Signature
Is 84.35 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund