163174 09/03/2008 CITY OF CARMEL INDIANA VENDOR: 358408 Page 1 of 1
ONE CIVIC SQUARE TIFFANY DETERS CHECK AMOUNT: $50.86
CARMEL, INDIANA 46032 6264 N CENTRAL
INDIANAPOLIS IN 46220 CHECK NUMBER: 163174
CHECK DATE: 9/3/2008
DEPARTMENT ACCOUNT PO N IN VOICE NUMBER AM OUNT DESCRIPTION
1046 4343000 50.86 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM N0. 1D1 (1986)
MILEAGE CLAIM
TO
5 �QC
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO, FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER
DATE FROM TO READING AUTO MILEAGE MILES
0 o�0� g POD POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MILE
1 D bko Ce a 0 of
le Iq p Cry cl kS U 02 l O
�fa3 oar o
.�G c o
J CI G� k C7� 7 S
jr)el� moil
tg
V X V
Y
1 AUTO, LICENSE NO. TOTALSGi�
SPEEDOMETER READING columns are to be used only when distance between points cannct 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 #ter allowing all just credits
end that no part of the same has been paid.
Date
PRESCRIBED BY STATE BOARD OF ACCCUNT9
GENERAL FORM NO, 101 (1986)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO, FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE G READING
NATURE OF BUSINESS MILES
POINT POINT START FINISH TRAVELED
PER MILE
010 G c r
Ina 1 5
L
3 v /lo s
C- a d ✓lv►'1 S
LO
dY1
s
/5 Lo
GI C a
o 0o ko
e Or i
y
`7
y
i Y
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 Inap.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after' Bowing all just credits,
.end that no part of the same has been paid,
Date
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
5130 Primrose Ave Date Due
Indianapolis, IN 46205
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/11/08 Reimb. Mileage 6/1/08 6/26/08 50.86
Total 60.86
I 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 PLEbSE Allowed 20
5130 Primrose Ave M A kL_
Indianapolis, IN 46205 CPELY-
In Sum of
50.86
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or Board Members
Dept ept INVOICE NO. ACCT #/TITLE AMOUNT
1046 Reimb. 4'343000 50.86 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
Signature
50.86 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund