165162 10/29/2008 a CITY OF CARMEL, INDIANA VENDOR: 360144 Page 1 of 1
ONE CIVIC SQUARE CYNTHIA CANADA
CHECK AMOUNT: $98.27
CARMEL, INDIANA 46032 11508 LUCKY DAN DRIVE
NOBLESVILLE IN 46060 CHECK NUMBER: 165162
CHECK DATE: 10/29/2008
CEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER A MOUNT DESCRIPTION
^;'1046 4343000 98.27 TRAVEL FEES EXPENSE
LR
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. SCI U"5)
MILEAGE CLAIM
rT
(GOVERNMENTAL UN117}
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTME2(T OR INS7YMION)
SPEEDOMETER AUTO AGE
DATE FROM TO I READING NATURE OF BUSINESS MILES r
2-0- POINT POINT START FINISH TRAVELED PER MILE
'1 z;> n re i n
1 0 n1p 0
o
m; n
17 L4 I
r
1 Tom.
r
r
iTA71 L4
Ana r 3
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 1553, I hereby certify that the fOTegoirg account is just and correct, that the amount claimed is legally due, after allowing all just credits r
and than no ari of he�s has been paid,
Date 1 V v x v
OCT 1 4 2006
PRESCRIBED BT STATE BOARD OF ACCOUNTS GENERAL FORM I10 161 (14BB)
MILEAGE CLAIM C
T O 4�
IGOVERNMENFAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF7ICE. BOARD, DEPARTA@rr OR INSTITUTION)
SPEEDOMETER AUTOdIS SAGE
DATE FROM TO READING MILES a
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MILE
L%Z-
.-A v
rn ems-- o
e- vi_ X
�rl
2 n
(wD ry
e—
—t ��1 orb e��.
C>,
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 alimving a11. just credits
end that a of t 0 e sa as been paid.
f
Date
OCT 1 ?n
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.
360144 Canada, Cyndi Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/8!08 Reimb. Mileage 8121108 10/08/08 98.27
Total 98.27
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.
360144 Canada, Cyndi Allowed 20
In Sum of
98.27
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343000 98.27 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
15 -Oct 2008
V-)
Signature
98.27 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund