166868 12/10/2008 CITY OF CARMEL, INDIANA VENDOR: 360472 Page 1 of 1
t ONE CIVIC SQUARE LYNN RUSSELL CHECK AMOUNT: $23.57
CARMEL, INDIANA 46032 829 DESERT WIND COURT
i•.
CARMEL IN 46032 CHECK NUMBER: 166868
CHECK DATE: 12/1012008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4343000 REIMB 23.57 TRAVEL FEES EXPENSE
it
PRESCRIBED BY 67ATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (I0S)
MILEAGE CLAIM F'1 J t
TO
(GOVERNMENTAL UNIT ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, HOARD, DEPARTMENT OA 1NRTITMtot,I
DATE FROM TO SPEEDOMETER AUTO MILEAGE
READING f [�F
POINT POINT FINISH NATURE OF AUSINESS TRAVELED c
PEA MILE
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AUTO LICENSE NO. TOTALS 3
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, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is lVal due, after alii win all just cre�igQ
end that no p rt of the same has been paid. f
Date
"4" v f y
DEC 0 1 2008
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.
360472 Russell, Lynn Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/1/08 Reimb. Mileage 7/2/08 10/28/08 23.57
Total 23.57
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.
360472 Russell, Lynn Allowed 20
If}
In Sum of
23.57
ON ACCOUNT OF APPROPRIATION FOR
101 General
PO# or INVOICE NO. ACCT #[TITLE AMOUNT Board Members
Dept
1125 reimb. 4343000 23.57 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
3 -Dec 2008
Signature
23.57 Business Services Manager
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund