163927 09/17/2008 CITY OF CARMEL, INDIANA VENDOR: 360204 Page 1 of 1
ONE CIVIC SQUARE SAMUEL RICHARDSON
0 1, CARMEL, INDIANA 46032 11109 ECHO CREST EAST DRIVE CHECK AMOUNT: $111.15
INDIANAPOLIS IN 46280
CHECK NUMBER: 163927
CHECK DATE: 9/17/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343000 111.15 TRAVEL FEES EXPENSE
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PRESCRIBED BY STATE BOARD OF ACCOUNTS C 1 1 V
y R1D GENERAL FORM NO. 101 (1986)
S EP 0 2 MILEAGE CLAIM G
208 TO-
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER AUTO k;ER I AG
NATURE OF BUSINESS
DATE FROM To 11EADING MILES
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2G0 o POINT POINT START FINISH TRAVELED MILE
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AUTO LICENSE NO. TOTALS V
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, a r allowing all just credits
and that no part of the same has been paid.
Date 2�c2K'"0
C1 m NE Warrant xe I have e amine the within cl mad hereby
IN FAVOR OF certify as follows:
That aa in proper form.
That it a duly authenticated as required
by law
That it is based upon statutory authority
f T correct correct hl it encore!
Disbursing Officer
On Account of Appropriation K& er
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in the sum of
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(Board eCommission) 22
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(Official Title)
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A_BOY CO, INC. _CIE, IN 01136 t:1 M
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.
360204 Richardson, Sam Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/28/08 reimb. Mileage 8/4/08 8/28/08 111.15
Total 111.15
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
1 20
Clerk- Treasurer
i
Voucher No. Warrant No.
360204 Richardson, Sam Allowed 20
In Sum of
111.15
ON ACCOUNT OF APPROPRIATION FOR
104 Program
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 reimb. 4343000 111.15 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
2 -Sep 2008
I L va 1o0 -may
Signature
111.15 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund