193153 12/22/2010 CITY OF CARMEL, INDIANA VENDOR: 356837 Page 1 of 1
0 ONE CIVIC SQUARE MICHELLE KRCMERY CHECK AMOUNT: $97.75
CARMEL, INDIANA 46032 433 AUTUMN DRIVE
CARMEL IN 46032
CHECK NUMBER: 193153
CHECK DATE: 12/22/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1160 4343004 97.75 TRAVEL PER DIEMS
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAI n
TO �A J
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
0 DA0 READING NATURE OF BUSINESS MILES So x
POINT POINT START FINISH TRAVELED PER MILE
5 5 2 C n .F
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'15 2ZIC, C 1 4 K Z 2
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2
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61 rk
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9 2W, 5
AUTO LICENSE NO. TOTALS
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
and that no part of the same has been paid.
Date 1 d
7. t
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form.
That it is duly authenticated as required
by law
That it is based upon statutory authority.
That it is apparently correct
incorrect
Disbursing Officer
On Account of Appropriation No. for
o w a
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R.
A.E. BOYCE CO., INC. MUNCIE, IN 01136
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORM NO. 101 (ISB&)
MILEAGE CLAI
To s �c t� e,r A�-.in y-� Cs. r�w� �f b 3 Z
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER
DATE FROM TO READING AUTO MILEAGE
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MILE
9 hA U U
°1 d-
2.
1 U U
10 •2
it it s Z
113
b
p t�
1
T d
1 d hT. r Af cw65 i z e
+j2 ti.
1 1 1 V' -s
AUTO LICENSE NO. TOTALS
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
and that no part of .the same has been paid.
Date
P, Ci
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
..That it is in proper form.
That it is duly authenticated as required
by law
That it is based upon statutory authority
That it is apparently correct
incorrect
Disbursing Officer
On Account of Appropriation No. for
o tr a
O 0
0 N a
n
M t:r
Allowed 19 0 a
a
m
in the sum of m
m
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0 '4 (Board or Commission) O �j
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FILED ro
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(Official Title) o o
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G, tr'N•
R.E. BOYCE CO., INC. MUNCIE, IN 01136 0
VOUCHER NO. WARRANT N O.
ALLOWED 20
Michelle Krcmery
IN SUM OF
433 Autumn Drive
Carmel, IN 46032
$97.75
ON ACCOUNT OF APPROPRIATION FOR
Mayor's Office
PO# Dept. INVOICE NO. ACCT# /TITLE AMOUNT Board Members
1160 Mileage Claim 43- 430.04 $9775 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
Monday, December 20, 2010
5
Mayor
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or 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.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/20/10 Mileage Claim $97.75
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