192910 12/15/2010 CITY OF CARMEL, INDIANA VENDOR: 364943 Page 1 of 'I
o ONE CIVIC SQUARE VICKI RUBIO CHECK AMOUNT: $66.50
CARMEL, INDIANA 46032
CHECK NUMBER: 192910
CHECK DATE: 12/15/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 66.50 TRAVEL FEES EXPENSE
I
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENFAAL -FORM NO. 101 11
MILEAGE CLAIM
TO Vic, i c l I
1 E [pOVFAN>.tENTAL DN111
ON ACCOUNT OF APPROPRIATION NO. FOR
tO"CK, BOARD, DWAIMaNf OR INSTITITT N7
FROM TO SPEEDOMETER AUTO
POINT POINT 6 µiLEAG£
DATE I READING i
1 START FINISH NATURE OF BUSINESS TRAVELED
PER MILT
G7 2 ru
e C 1
Co Ilt it (L C f o o
4 r
r' S
5
t L m� ?rw 1 7 I
t GJ
Lim
i
117 15t cr-A 'P W o 3
i t Y a I
c Aj
t a
Cn 6010
/,Z rnku G D l�'lDi�dcti Y i s
AUTO LICENSE NO, TOTALS 1
1 .3 1 �ji 5a
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, aftaT a wing all just credits
and that no p of the same has been paid.
Dale I/, d� i I 1 V
1 10(0 d�
I 1�
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.
Rubio, Vicki Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
11/24110 Reimb Mileage 11/1 11/24/10 66.50
Total 66.50
I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and 1 have audited same in accordance
with IC 5- 11- 10 -1.6
20
Clerk- Treasurer
Voucher No. Warrant No.
Rubio, Vicki Allowed 20
In Sum of
66.50
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -3 Reimb 4343000 66.50 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
9 -Dec 2010
Signature
66.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund