162019 07/23/2008 *f CITY OF CARMEL, INDIANA VENDOR: 360204 Page 1 of 1
ONE CIVIC SQUARE SAMUEL RICHARDSON
CARMEL, INDIANA 46032 11109 ECHO CREST EAST DRIVE CHECK AMOUNT: $26.26
INDIANAPOLIS IN 46280
CHECK NUMBER: 162019
CHECK DATE: 7/23/2008
DEPARTMENT ACCOUNT PO NUMB INVOICE NUMBER A MOUNT DESCRIPTION
1046 4343000 26.26 TRAVEL FEES EXPENSE
Fi4
f
PRESCRIBED BY STATE BOARD OF ACCOUNTS
r ERAL-FORM-NO-101 GEN (1986)
MILEAGE CLAIM JUL 0 8
TO (/l/L 6 G- SU
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER
DATE FROM TO READING AUTO MILER E
Z�y NATURE OF BUSINESS MILES �0 c
POINT POINT START FINISH TRAVELED
PER MILE
-:Z f t tr
it
Z
3
Z�
Z
Z
1r
It
1<
3 I �f !I
r r
AUTO LICENSE NO. TOTALS 7 1i
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 du after allowing all just credits
znd that no part of the same has been paid.
Date
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.
Richardson, Sam Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/27/08 reimb. Mileage 3/31/08 5/13/08 26.26
Total 26.26
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.
Richardson, Sam Allowed 20
In Sum of
26.26
ON ACCOUNT OF APPROPRIATION FOR
104 Program
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 reimb. 4343000 26.26 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
18 -Jul 2008
U
Signature
26.26 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund