166324 11/24/2008 CITY OF CARMEL, INDIANA VENDOR: 356305 Page 1 of 1
ONE CIVIC SQUARE DARRELL D NORRIS CHECK AMOUNT: $101.79
CARMEL, INDIANA 46032 101 2ND AVE SW, #2C
CARMEL IN 46032 CHECK NUMBER: 166324
CHECK DATE: 11/24/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1160 4343004 MILEAGE 101.79 TRAVEL PER DIEMS
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PRESCRIBED BY STATE BOARD OF ACCOUNTS yp_✓d, P�� C GENERAL FORM NO. 101 (1986) r
MILEAGE CLAIM
TO
/(GOVERNMENTAL UNIT)
j/� L _AlblelelJ'J ON ACCOUNT OF APPROPRIATION NO. FOR
J (OFFICE, BOARD, DEPARTMENT OR INSTITU OON))
DATE FROM TO READING SPEEDOMETER AUTO MILEAGE
NATURE OF BUSINESS MILES Qa W Q
POINT POINT START FINISH TRAVELED PER MILE
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AUTO LICENSE NO. TOTALS Q/
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, after allowing all just credits
and that no part of the same has been paid.
Date
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form.
That it is duly authenticated as required
by law
That it is based upon statutory authority.
That it is apparently correct
incorrect
Disbursing Officer
On Account of Appropriation No. for
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PrescribetlRSy State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
ffi CITY OF CARMEL
11/24/08
An invoice or 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
Darrell Norris Purchase Order No.
One Civic Squ. Terms
Carmel IN 46032 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
11/19/08 Mileage Lox Mileage reimbursement for Darrell Norris for City 101.79
of Carmel business
Total $101.79
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
VOUCHER NO. WARRANT NO.
!11/24/08 ALLOWED 20
Darrell Norris IN SUM OF
One Civic Sq
Carmel In 46032
101.79
ON ACCOUNT OF APPROPRIATION FOR
1160 Mayor 4343004
Travel Per Diem
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
Mileage Log 4343004 $101.7 9 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
20
Signa re
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund