164907 10/16/2008 CITY OF CARMEL, INDIANA VENDOR: 360204 Page 1 of 1
ONE CIVIC SQUARE SAMUEL RICHARDSON
i 0 CHECK AMOUNT: $98.28
CARMEL, INDIANA 46032 11109 ECHO CREST EAST DRIVE
ti, o INDIANAPOLIS IN 46280 CHECK NUMBER: 164907
CHECK DATE: 10/16/2008
DE PARTMENT ACC OUNT PO NUMBER INVOICE NUMBER AMOU DESCRIPTION
1046 4343000 98.28 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM C.
TO
(GOVERNMENTAL. UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER
DATE FROM To READING NATURE OF BUSINESS MILES S AS 0
zoo POINT POINT START FINISH TRAVELED PER MILE
O
Wq
l JL( O'1 r7 rl W c I 7
VV\, U o �G h)aa lJpr j� r
0
Co wo
c
3
K— Ir
nc S Gt
7.✓dr Jci L
.'j C9 c L pP• (vc, r :.i c r 12--
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 claimedlis legally due, after allowing all just credits,
znd that no part of the same has been paid.
2 C F—TV D
Date 0 C T 0.1 2008
BY:
ACCOUNTS PAYABLE VOUCHER
't 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.
360204 Richardson, Sam Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/30/08 reimb. Mileage Sep'08 98.28
Total 98.28
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.
360204 Richardson, Sam Allowed 20
In Sum of
98.28
1�
ON ACCOUNT OF APPROPRIATION FOR
104 Program
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 reimb. 4343000 98.28 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
98.28 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund