164208 09/30/2008 CITY OF CARMEN., INDIANA VENDOR: 358408 Page 1 of 1
ONE CIVIC SQUARE TIFFANY DETERS
CARMEL, INDIANA 46032 6264 N CENTRAL CHECK AMOUNT: $155.55
INDIANAPOLIS IN 46220 CHECK NUMBER: 164208
CHECK DATE: 9/30/2008
DE A CCOUNT PO N INVOI NU MBER A MOUNT D
1046 4343000 155.55 TPLAVEL EXPENSE
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM —T
TO
(GOVERNMENTAL UNIT)
F ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILE AG
DATE T READING MILES
49 a POTAIT PdINT STA�iT FINISH NATURE OF BUSINESS TRAVELED PER MIL
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AUTO LICENSE NO. TOTALS ZU51 0,l
SPEEDOMETER READING columns are to o -be used only when distance between points cannot be determined by fixed mileage or official highway map. SS
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoi 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 f
�1
Claim No. Warrant No. l 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� s x a
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in the sum of
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G•
A.E. BOYCE CO., INC. MUNCIE, IN 01135 4• 0 M
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.
358408 Deters, Tiffany Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/26/08 Reimb. Mileage 07/14/08 8/26/08 155.55
Total 155.55
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.
358408 Deters, Tiffany Allowed 20
In Sum of
155.55
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343000 155.55 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 -Sep 2008
Signature
155.55 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund