166566 12/10/2008 CITY OF CARMEL, INDIANA VENDOR: 360484 Page 1 of 1
ONE CIVIC SQUARE AMY BALDAUF
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CARMEL, INDIANA 46032 126 LARK DR CHECK AMOUNT: $278.82
APT D CHECK NUMBER: 166566
CARMEL IN 46032
CHECK DATE: 12/10/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343000 278.82 TRAVEL FEES EXPENSE
PRESCWB£D BY STATE BOARD OF ACCOUNTS GERRIIAL FORM NO. 361 tMb)
MILEAGE CLAIM
(3OVER1;MWITAL ONITI 1
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD" DEPARTMENT OR INSTITUTIONI
SPEEDOMETER
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FROM TO S M
POINT POW START FINISH TRAVELED P R KILE
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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 aliowing all just credits
and that no part of the same has been paid.
Date
I
DEC 0 5 2008
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1996)
MILEAGE CLAIM
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE. BOARD, DEPAFID0 T OR INSTITTJTION)
DAT FROM TO SPEEDOMETER AUTO
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READING NATURE OF BUSINESS MILES x
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SPEEDOMETER READING columns are to Be used only when distance between points cannot be determined by fixed mileage or official highway map. �1!
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 aliowing all just credits
end that no part of the same has been paid.
Date
DEC 0 5 2008
a T
ORIGI
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL PORM NO. I0I (1985)
MILEAGE CLAIM U y
TO �r_f nil y 4 JV`l d CX
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE. BOARD, DEPARTMENT OR INSTITUTION)
FROM TO S�BQ G +ER AUTO MILEAGE
KLES POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MILE
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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
i V
DE 0 5 2008
1
OR
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1%5)
MILEAGE CLA \j oJd A
I'l� '_lam
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER
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AUTO LICENSE NO. TOTALS g I
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
DEC 0 5 2008
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Pursuamt to the provixions and penalties ei Chapter IS5, Acts 1553, I bereby certify that The foregoing acocuut is jusA and rorcect, that the ikommt claimed is legally due, after aUawinq au just credits
end That no Part of the same has been paid.
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SPEl3Dt7MSl KR READING comma are Iv be used only when distance batmon points cavnol be dutexmined b-i lived mileage -or -of icial•bighway -map.
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Pumaant to the provbfi s and penallies of Chapter 155, Acts 1953, I hereby oortilythal Lbe foregoing account is iuM aaa cwrecl, U6il 6- amocintc ed is legally due, alter atiowing all just credits,
and Thal no pail of the same has been paid. D EC 0 20 08
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SPEFDOMEM READING columns ace io be use only when distance bstwsan painh cannel be d2kernined by fired mileage or alliclO highwny mep.
Forsuanl to !h8 provisioms and pena$ies of Chapter 155, Acts 1663,1 hemby codify that Lbe loregcing accmat is;ast and correct, thal the amekmt claimed is legally due, alter aHowin g all just eredii:5
end that mo part cl the Brae bas been pall.
Date ff
-Ar D
DEC 0 1 2008
0
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.
Terms
360484 Baldauf, Amy
Date Due
Invoice Invoice Description
Date Number
or note attached invoice(s) or bill(s)) Amount
11125108 reimb. Mileage 7/11/08 11125108
2 78.8 2
Total 278.82
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
i
Voucher No. Warrant No.
360484 Baldauf, Amy Allowed 20
In Sum of
278.82
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 reimb. 4343000 278.82 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
1
1 -Dec 2008
Signature
278.82 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund