164356 09/30/2008 i
CITY OF CARMEL, INDIANA VENDOR: 356305 Page 1 of 1
ONE CIVIC SQUARE DARRELL D NORRIS
s 0 CHECK AMOUNT: $142.41
�jo CARMEL, INDIANA 46032 101 2ND AVE SW, #2C
CARMEL IN 46032 CHECK NUMBER: 164356
CHECK DATE: 9/30/2008
bEPARTMENT ACCOUNT PO NUMB INVOICE NUMBER AMOUNT DESCRIPTION
1160 4343004 116.41 TRAVEL PER DIEMS
,1160 4355100 26.00 PROMOTIONAL FUNDS
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PRESCAIBED BY STATE BOARD OF ACCOUNTS
y Py 1 c GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
TO
r O e7cl C GOVERNMEN UNIT &C-
A
V ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR STITUTION)
DATE FROM TO SPEEDOMETER READING AUTO MILEAGE
�9� POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MILE
AI M A110 7 c— l7 11V cC dA'/tt
4 1 ;2
D 5 7 /2 11 T 7't� �O, o �v .e•T�
O Gam✓!// ee
ell V X176 8
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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 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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Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
9/29/08 CITY OF CARMEL
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 Square Terms
Carmel IN 46032 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
9/26/08 Recei t CICCA Meeting parking $16.00
9/15/08 Recei t Energy conference parking $10.00
9/26/08 Milea e Log Mileage reimbursement while on city business $116.41
Total $142.41
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.
9/2/08
ALLOWED 20
Darrell Norris IN SUM OF
One Civic Square
Carmel IN 46032
$142.4
ON ACCOUNT OF APPROPRIATION FOR
1160 Mayors 4355100 4343004
Promotional Funds
Travel Per Diem Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
REcei t 4355100 $16.00 bill(s) is (are) true and correct and that the
Receipt 4355100 $10.00 materials or services itemized thereon for
Mileage Lo R 4343004 $116.41 which charge is made were ordered and
received except
20
ignature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund