166862 12/10/2008 CITY OF CARMEL, INDIANA VENDOR: 360204 Page 1 of 1
ONE CIVIC SQUARE SAMUEL RICHARDSON CHECK AMOUNT: $57.33
?o CARMEL, INDIANA 46032 11109 ECHO CREST EAST DRIVE
INDIANAPOLIS IN 46280 CHECK NUMBER: 166862
CHECK DATE: 12/10/2008
DvPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343000 REIMB 57.33 TRAVEL FEES EXPENSE
a
PRESCRIBED BY STATE BOARD OF ACCOUNTS I GENERAL FORM 110. 101 (1111,
MILEAGE CLAIM
L TO
(GOVERNMENTAL vxrr) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER
DATE FROM TO READING AUTO MILEAGE
NATURE OF BUSINESS MSS 8 c
19_ POINT POINT START FINISH TRAVELED PER MILE
I/ f 1 ev, l P I' i" C1C:s �..�ir/' .f
iA 19
oil /,r
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AUTO LICENSE NO. TOTALS 5 7.
SPEEDOMETER READING columns are to be used only when distance between points cannot be (letermined 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, after allowing all just credits
.end that no part of the same has been paid.
ID
a te
ACCOUNTS PAYABLE VOUCHER
f 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
v Purchase Order No.
360204 Richardson, Sam Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/26/08 reimb. Mileage 11/6/08 11/26/08 57.33
Total 57.33
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
Voucher No. Warrant No.
360204 Richardson, Sam Allowed 20
In Sum of
57.33
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 reimb. 4343000 57.33 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 -Dec 2008
Signature
57.33 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund