164762 10/16/2008 CITY OF CARMEL, INDIANA VENDOR: 360926 Page 1 of 1
ONE CIVIC SQUARE SHAVONNE HOLTON CHECK AMOUNT: $52.94
CARMEL, INDIANA 46032 8001 CANARY LANE, APT A
INDIANAPOLIS IN 46260 CHECK NUMBER: 164762
CHECK DATE: 1011612008
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DEPARTMENT ACCOUNT P O NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2046 4343000 52.94 TRAVEL FEES EXPENSE
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PRISCRIBED BY STATE BOARD OF ACCOIJM GENERAL FORM i(O. 101 11 48 67
MILEAGE CL O-n"G O o k
�6OVFA1t�1ENTAL Uifl'n
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF71CL, BOARD. DUARR41371 OR 1tisr=I0R)
SPEEDOMETER
11 FROM TO j READING AUTO MILEAGE
NATURE OF BUSINESS MMES
Ste± L POINT POINT START FINISH TRAVELED PER ALE
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AUTO-LICENSE NO. T TOTALS 52 R O� y
SPEEDOMETER READING columns are tor be used only when distance between points cannot be determined by fixed mileage or official highway- map.
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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 claims s le 11 d e, al a 'owing all just credits r
and that no part of fhe same h been paid.
Date
r
s E P 3 0 2008
BY:
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.
360926 Holton, Shavonne Terms
8001 Canary Ln Apt A Date Due
Indianapolis, IN 46260
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/25108 Reimb. Mileage 8125/08 09/24/08 52.94
Total 52.94
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
f
i
Voucher No. Warrant No.
360926 Holton, Shavonne Allowed 20
8001 Canary Ln Apt A
Indianapolis, IN 46260
In Sum of
52.94
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT#1TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343000 52.94 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
1 -Oct 2008
Signature
52.94 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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