166233 11/24/2008 CITY OF CARMEL, INDIANA VENDOR: 358411 Page 1 of 1
ONE CIVIC SQUARE JENNIFER HAMMONS CHECK AMOUNT: $165.56
CARMEL, INDIANA 46032 10868 GUNNISON CT
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FISHERS IN 46038 CHECK NUMBER: 166233
CHECK DATE: 11/24/2008
DEPARTMENT ACCOUNT P O NUMB INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343000 165.56 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM RO. 101 (198b)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNPIN ON ACCOUNT OF APPROPRIATION NO. FOR 0 �'P U r c xf�1M�
(OFFICE, BOARD, DEPARTMENT OR 1NSTrrUI10N)
SPEEDOMETER
DATE FROM TO I READING AUTO MILEAGE
dG MILES NATURE OF BUSINESS MILES 5tS•5 C
2 POINT POINT START FINISH TRAVELED PER MILE
C
U`k
d Ct
O C- k- U
Oct
OcA 01\
CS C-+ to o W C
cc-* i L "C i c1�- ,t t M Q""� r.W G
G�k Z Wt- c
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C)! z.cb 11 cf
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7 g 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 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally e, aft ali ing all ust credits.-
end that no part of the same has been paid.
Date
Tom, M
C-F NOV
NOV 0 5 2008
B Y. Y:
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.
358411 Hammons, Jennifer
Terms
10868 Gunnisan Ct Date Due
Fishers, IN 46038
Invoice Invoice Description
Date Number
or note attached invoice(s) or bill(s)) Amount
165.56
11/5/08 Reimb. Mileage Oct'08
Total 165.56
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
i
Voucher No. Warrant No.
358411 Hammons, Jennifer Allowed 20
10868 Gunnisan Ct
Fishers, IN 46038
In Sum of
r 165.56
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT#ITITLE AMOUNT Board Members
Dept
1046 Reimb. 4343000 165.56 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
17 -Nov 2008
Signature
165.56 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I