192679 12/10/2010 CITY OF CARMEL, INDIANA VENDOR 364002 Page 1 of 1
ONE CIVIC SQUARE ASHLEY LIVINGSTON CHECK AMOUNT: $107.00
�t CARMEL, INDIANA 46032 3404 WOODFRONT PLACE
INDIANAPOLIS tN 46222 CHECK NUMBER: 192679
CHECK DATE: 12110/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 107.00 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GUERXL FORM NC. ICI 09SS)
MILEAGE CLAIM
To
IC;O MENTAL UNI'n
ON ACCOUNT OF APPR PRIATiON Np. FOR
(OmCE. B "D, DEPART&WIT OR INSTITLRtON)
FROM TO SPEEDOMETER
AUTO MILEAGE
DATE HEADING
NATURE OF 81fSINES MILES (ey r
POINT POINT START FINISH TRAVELED PE MILE
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G) e. Id- C'Q !n Iaw
-1 C 7 7
N od -7 r (91,
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AUTO LICENSE NO- TOTALS LA
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 all just credits
and that no part of the same has been paid.
Date
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.
364002 Livingston, Ashley Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
11124/10 Reimb Mileage 10/18 11/24/10 107.00
Total 107.00
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.
364002 Livingston, Ashley Allowed 20
In Sum of
107.00
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -2 Reimb 4343000 107.00 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
9 -Dec 2010
Signature
107.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund