194096 02/03/2011 CITY OF CARMEL, INDIANA VENDOR: 359600 Page 1 of 1
ONE CIVIC SQUARE HELEN BALLINGER
CHECK AMOUNT: $26.78
CARMEL, INDIANA 46032 12913 CURRIER STREET
CARMEL IN 46032 CHECK NUMBER: 194096
CHECK DATE: 2/3/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4343000 26.78 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE HOARD OF ACCOUNTS GENP,RAL FORM No. 101: (1985)
MILEAGE CLAIM
TO 1 LWr
3vVEANMENT E uNtTt ON ACCOUNT OF APPROPRIATION NO.. FOR
r1 eP
[O'C: (C£, ARO; tltPAA'tMENT.OR I}t57FMION)
FRO TQ T SPEEDOMETER AUTO MILEAGE
Z DA T 1 READING
NATURE OF BUSINESS MILES
POINT 1 POINT START FINISH TRAVELED PER MILE
I m C 1A) 05
I o
oK -w f4L
0
io r
rt
1l1 n1 K a E�4r
j tt
I f I II ii
jam
it q e S r I
AUTO LICENSE NO, TOTALS
SPEEDC)METER READING columns are to be used only when distance between points cannot be determined by #ixed,mileage or official highway map
Pursuant to the provisions and penalties of Chapter 155, Acts 19 @3, I hereby certify that the foregoing account is just and correct, that the amount Maimed is legally e, a n all just credit
end that no part of the same has been paid,
Date
17 7 7
JAN 19 2011
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.
359600 Ballinger, Helen Terms
12913 Currier Street
Carmel, iN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1119111 Reimb Mileage 9123110 1113/11 26.78
Total 26.78
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.
359600 Ballinger, Helen Allowed 20
12913 Currier Street
Carmel, IN 46032
In Sum of
26.78
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 Reimb 4343000 26.78 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
27 -Jan 2011
x 4 z
Signature
26.78 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund