192648 12/10/2010 CITY OF CARMEL, INDIANA VENDOR: 360926 Page 1 of 1
4 ONE CIVIC SQUARE SHAVONNE HOLTON CHECK AMOUNT: $103.00
r CARMEL, INDIANA 46032 3707 N MERIDIAN ST APT 3B
INDIANAPOLIS IN 46208 CHECK NUMBER: 192648
CHECK DATE: 12110/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 103.00 TRAVEL, FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO- 101 0%5)
MILEAGE CLAIM
ro
(GOVERNMENTAL UNI'I1
ON ACCOUNT OF APPROPRIATION NO. FOR
(oiitcE BOARD, OE➢ARTYPNT on INsurunoN)
AUTO
FROM TO SPEEDOMETER MIL£
DATE I READING
P
NATURE OF BUSINE56
FOINT POINT START FINISH 1'AAVELED
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AUTO LICENSE NO- TOTALS
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 clai isle ly ue, a ali wing all just credits,-
end that no. xt f the same has been paid.
Date 1'2J
loll 4J rc L., OEc 0 6 2010
R- P �I
7
PRESCRIBED BY STATE eOARO OF ACCOUNTS �LFOXM W 1 1 (1466)
MILEAGE CLAIM 1 J
(OOVERNWENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
tOFiECE, HOARD, DF9ARTMENT OR 1NST' IIgN)
FROM TO f- SPEEDOMETER AUTO MILEAGE
READING MILES
F- �Q—
MATURE OF AUSINE56 TRAVELED
POINT POINT START FINISH PER MILE
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4 �O AUTO LICENSE NO- TOTALS
t 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 legally d a er aliowing all just credits
and that no part f the same has been paid,
Date Il l C) i
V [1 1
DEC 0 8 2010
lL y: •...a a
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.
360926 Holton, Shavonne Terms
8001 Canary Ln Apt A Date Due
Indianapolis, IN 46260
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1212110 Reimb. Mileage 813 9123/10 55.00
12!6110 Reimb. Mileage 10/7 11/23/10 48.00
Total 103.00
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
i
Voucher No. Warrant No.
360926 Holton, Shavonne Allowed 20
8001 Canary Ln Apt A
Indianapolis, IN 46260
In Sum of$
103.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #!TITLE AMOUNT Board Members
Dept
1081 -1 Reimb. 4343000 55.00 1 hereby certify that the attached invoice(s), or
1081 -1 Reimb. 4343000 48.00 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
103.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund