159321 05/14/2008 CITY OF CARMEL, INDIANA VENDOR: 361231 Page 1 of 1
ONE CIVIC SQUARE LINDSEY DUFFY
CARMEL, INDIANA 46032 830 PARK CENTRAL DR S APT C CHECK AMOUNT: $18.68
INDPLS IN 46260
CHECK NUMBER: 159321
CHECK DATE: 5/14/2008
DEPARTMENT C "ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1.160 4343004 18.68 TRAVEL PER DIEMS
V'3 Y3 6
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PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORM NO. 101 (1986;
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT) V 1
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
DATE G FROM TO SPEEDOMETER T
AUTO MILEAGE
l7 o NATURE OF BUSINESS MILES
POINT POINT START FINISH TRAVELED PER MILE
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AUTO LICENSE NO. TOTALS 18
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 allowing all just credits
and that no part of the same has been paid.
I 2
Date I to CJ 1 �i
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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A.E. BOYCE CO., INC. MUNCIE, IN 01136
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Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
x/12/08 ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
L
An invoice or 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
Lindsey Duffy Purchase Order No.
112 Chelthonham Drive Terms
Normal IL 61761 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
3 7 07 Mileage Log Mileage reimbursement for City of Carmel business $18.68
Total $18,68
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.
5/12/08
ALLOWED 20
Lindsey Duffy IN SUM OF
112 Cheltonham Drive
Normal IL 61761
18.68
ON ACCOUNT OF APPROPRIATION FOR
1160 Mayors 4343004
Travel Per Diem
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
Mileage Log 4343004 $18.68 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
20
S, 9 natur
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund