161715 07/23/2008 CITY OF CARMEL, INDIANA VENDOR: 360484 Page 1 of 1
ONE CIVIC SQUARE AMY BALDAUF
CARMEL, INDIANA 46032 9441 BENCHMARK DR APT B CHECK AMOUNT: $253.43
INDIANAPOLIS IN 46240 CHECK NUMBER: 161715
CHECK DATE: 7/23/2008
DEPARTM ACCOUNT PO NUMB INVOICE NUMBE AMOUNT D ESCRIPTION
1046 4343000 253.43 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE HOARD OF ACCOUNTS
GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM .G�i
TO
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER
DATE FROM TO READING AUTO 6E
Q�t r. ppnJT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MILE
r,
Out
5 ..5
=7
Oc
ci'
V
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 rnap. I
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, fter allowing' all just credits,
Ind that no part of the same has been paid.
bate
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 161 (1986)
MILEAGE CLAIM 4
TO (GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR J u ZOOS f
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING f MILES �j
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED MILE
Q
PER MILE
55 r��YYtlrl l:LI I t
1 1 Yl
0 t� 5r.
Qn t+ t, r+
�t t ct 5,S
Vi 1 9 t i
,�avt 5.5
JGU11� It r1
2 z f t+ 11 t c• 5
Q lf'1
e�)o
F6 2. t} Sr 5
ID 6 1 5S
i� li it
zZ
Vev
AUTO LICENSE NO. TOTALS
SPEEDOMETER READING columns are to be used only when distance between points be determined by fixed mileage or official highway map. YY�✓
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 du after allowing all just credits
and that no part of the same has been paid. ,J
Date
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENESAL FORM No. 101 (1986)
MILEAGE CLAIM
(GOYERNbfENTAL 1SNIT) ON ACCOUNT OF APPROPRIATION NO. FOR L 208
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER
DATE FROM TO REARING AUTO A E MILES N
4� POINT POINT START FINISH NATURE OF BUSINESS TRAVELED x
PER MLLE
t G1 V 1
NROLf
TAu
1 it id
_NAC
NA� 15
V
y' t 1 if
KArw 2n
-may" zz tt 1 1 1 V' 5.5
__WW Z3 yl 1
5' 5
May %i ,r �5
Y
2-cl 1
NAW
fln
4 11 to c'
r 20
5-
it
.AUTO, LICENSE NO. TOTALS i
SPEEDOMETER READING columns are to be used only when distance between points be determined by fixed mileage or official highway map, l
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, of r allowing' all just credits,
.and that no part of the same has been paid.
Date
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERp,I,_FORM NO. 101 (1966)
MILEAGE CLAIM
TO tf
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
ITTy
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO A E
DATE READING
MILES
i� POINT POINT START FINISH NATURE OF BUSINESS TRAVELED c
PER MILE
d
i� Lf
tv�a li C
.7 1-1 Ci
lU I
NOT p► l+ 5
'Mc u I� I.
NVA
1 1
5 J
NAA 4i
14 11 u
l l I I y,
L,
3 i
h Ir N rY a
i i It
It i i 5.5
U y,. Z� t f ti 15-5
n 1 if S 5
AUTO LICENSE NO. TOTALS
SPEEDOMETER READIN G 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 du after allowing all just credits
,end that no part of the same has been paid.
Date
f��A�
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.
Baldauf, Amy Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/27108 reimb. Mileage 8127107 11/06/07 45.35
6127/08 reimb. Mileage 1/5108 2/28108 69.36
6/27/08 reimb. Mileage 311108 4126108 69.36
6/27/08 reimb. Mileage 4127/08 8101/08 69.36
Total 253.43
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.
Baldauf, Amy Allowed 20
In Sum of
253.43
ON ACCOUNT OF APPROPRIATION FOR
i
104 Program Fund
PO# or INVOICE NO. ACCT#MTLE AMOUNT Board Members
Dept
1046 reimb. 4343000 45.35 1 hereby certify that the attached invoice(s), or
1046 reimb. 4343000 69.36 bill(s) is (are) true and correct and that the
1046 reimb. 4343000 69.36 materials or services itemized thereon for
1046 reimb. 4343000 69.36 which charge is made were ordered and
received except
16 -Jul 2008
9O,
Signature
253.43 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund