166567 12/10/2008 CITY OF CARMEL, INDIANA VENDOR: 359600 Page 1 of 1
ONE CIVIC SQUARE HELEN BALLINGER
CARMEL, INDIANA 46032 12913 CURRIER STREET CHECK AMOUNT: $36.80
CARMEL IN 46032 CHECK NUMBER: 166567
«ON
CHECK DATE: 12/10/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4343000 36.80 TRAVEL FEES EXPENSE
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PRESCRIBED BY STATE BOARD OF ACCOUNTS I /1 GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
TO
(GOVERNM TAL U I
T ON ACCOUNT OF APPROPR TION NO. FOR
1�5l 53 A/1 (i
(OFFIPE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING NATURE OF BUSINESS MILES @a 5P .5 0
RX POINT POINT START FINISH TRAVELED
PER MI
j 171 G
pt. !I I��N. �l( ✓G ox U
11+12 ✓!�fitL OLi. 4' �u�
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In
g ltK 0/14 c5i df,G(L'. Aia J
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A
LL
JOV 11 I1� f I 3
AUTO LICENSE NO. i TOTALS I
��y
SPEEDOMETER READING columns are to be used only when distance between points cannot be Bete `mined 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 le liowing all just credi s
end that no part of the same has been paid.
Date
J
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
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Allowed 19� k a a,
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in the sum of Q m ID
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(Board or Commission) P- th n
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FILED
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(Official Title) o
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A.E. ROYCE CO., INC. MUNCIE, IN 01136
�C n P.
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
359600 Ballinger, Helen
12913 Currier Street
Carmel, IN 46032
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
36.80
11128108 Reimb Mileage 9110108 11/20/08
Total 36.80
ice(s), or bill(s) is (are) true and correct and I have audited same in accordance
I hereby certify that the attached invo
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
36.80
ON ACCOUNT OF APPROPRIATION FOR
101 -General Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 Reimb 4343000 36.80 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 -Dec 2008
�&M
Signature
36.80 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund