165258 10/29/2008 CITY OF CARMEL, INDIANA VENDOR: 358411 Page 1 of 1
ONE CIVIC SQUARE JENNIFER HAMMONS CHECK AMOUNT: $214.11
CARMEL, INDIANA 46032 10868 GUNNISON CT
FISHERS IN 46038 CHECK NUMBER: 165258
CHECK DATE: 10/29/2008
DE PARTMENT ACCOU PO NU MBER I NUMBER AMOUNT DE v _r
1046 4343000 214.11 TRAVEL FEES EXPENSE
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 10) (1986)
MILEAGE CLAIM
TO �Vl t� t M,(� G. 6 1 \VYte 1
IGOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE. BOARD, DEPARTMENT OR 1NSTMITION)
SPEEDOMETER
DATE FROM TO I READING AUTO WI.EAGE_
fyr,� NATURE OF BUSINESS MILES Ua
POINT POINT START FINISH TRAVELED PER MILE
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AUTO LICENSE NO. TOTALS 3 c o (0
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. lU
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
end that no part of the same has been paid.
Date t o I r I
RF
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 ate Number or note attached invoice(s) or bill(s)) Amount
214.11
6/08 Reimb. Mileage Sep'08
Total 214.11
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
i
Voucher No. Warrant No.
358411 Hammons, Jennifer Allowed 20
10868 Gunnisan Ct
Fishers, IN 46038
In Sum of
214.11
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343000 214.11 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
1YY /M VA
Signature
214.11 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund