196530 04/13/2011 CITY OF CARMEL, INDIANA VENDOR: 364943 Page 1 of 1
ONE CIVIC SQUARE VICKI RUBIO CHECK AMOUNT: $82.11
CARMEL, INDIANA 46032
CHECK NUMBER: 196530
CHECK DATE: 4113/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 82.11 TRAVEL FEES EXPENSE
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PRESCRIBED HT STATE BOARD Or ACCOUNTS GFWFAAL FORM 110. 101 (1960
MILEAGE CLAIM `I
ccn to �f '�11'.i��► c�i �c�
IOOVERNMENTAL UNITE
ON ACCOUNT OF APPROPRIATION NO. FOR
IOri�CE, BOARD, DEPARTM U OR 1NSTMTIION)
SPEEDOMETER AGE
DATE FROM TO EiEAE1ING MILES
NATURE OF BUSINESS
POINT POINT START FINISH TAAVELBD PER MILE
Webk r
'It9 'L 5 1
AfL` Eel v 5
Meow Artvb 64 7
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AUTO LICENSE NO. TOTALS t
SPEEDOMETER READING columns are to be used only when distance between points cannot he determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after ing all just credits
end that n p$A of the same has been paid.
Date
1
APR 0 4 201 �l�" t a 4 zo��
]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.
364943 Rubio, Vicki Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
3/31111 Reimb Mileage 311 -3/31 82.11
Total 82.11
1 hereby certify that the attached invoice(s), or bills) 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,
364943 Rubio, Vicki Allowed 20
In Sum of
82.11
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -3 Reimb 4343000 82.11 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
7 -Apr 2011
Signature
82.11 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund