163158 09/03/2008 CITY OF CARMEL, INDIANA VENDOR: 361544 Page 1 of 1
ONE CIVIC SQUARE KEISHA BORUFF
CARMEL,. INDIANA 46032 5409 HOLLY SPRINGS DR W CHECK AMOUNT: $54.15
INDPLS IN 46254 CHECK NUMBER: 163158
CHECK DATE: 9/3/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343000 54.15 TRAVEL FEES EXPENSE
r�'
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORM NO. 101 (1966)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
DATE FROM TO R DING T +R AUTO MILEAGE
I9 NATURE OF BUSINESS MILES Q
POINT POINT START FINISH TRAVELED
PER MILE
IMUT
fiq t3gd�
nt 2 20O7 M o)A y f e -Iru 2 y Noi ZO j ci to 51 m Q- L
mbylgln Nl hNae, W I OLN l q J 16 n Ll 0✓
1 ZOD� 1 Gi W G1 m %nbyi fto fty Zl5 LA t 0 2.I 5H I I S im M i Oq
-tV 5 t 7 2a 5 1 U 2� 5g i
5 l ZSSy2t
C 'P le W 0 u2' SA/18
AUGTT Tom`
2008 1
I
AUTO LICENSE NO. TOTALS
i
e SPEEDOMETER READING columns are to be used only when distance between points 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 it of the same has been paid. L
Date 1
ACCOUNTS PAYABLE VOUCHER
n° 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.
361544 Boruff, Keisha Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/11/08 reimbursement Mileage 6/18/08 7/31/08 54.15
Total 54.15
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.
361544 Boruff, Keisha Allowed 20
in Sum of
54.15
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 reimbursement 4343000 54.15 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
18 -Aug 2008
Ne vi ohj
Signature
54.15 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund