155254 01/10/2008 I
CITY OF CARMEL, INDIANA VENDOR: 360679 Page 1 of 1
ONE CIVIC SQUARE PAIGE COAPSTICK CHECK AMOUNT: $18.58
i• /�o: CARMEL, INDIANA 46032 1435 SPRINGMILL PONDS BLVD
CARMEL IN 46032 CHECK NUMBER: 155254
CHECK DATE: 1/10/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1160 4343004 1212 18.58 TRAVEL PER DIEMS
i
PRESCRIBED BY STATE BOARD OF ACCOUNTS "GENh FORM NO. 101 (1986)
MILEAGE CLAIM -p S
�Q TO q-
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR I pi d 1 61 y d
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION) m e� V W
DATE FROM TO SPEEDO EADIING T +R AUTO MILEAGE �D 5
NATURE OF BUSINESS MILES Q s
I9 POINT POINT START FINISH TRAVELED
PER MILE
!a Y' o o S o S
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 oz g /0 I
JR-Wic
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.
correct
That it is apparently Sl incorrect
Disbursing Officer
On Account of Appropriation No. for
o tr a
a m o
CD
n m
Allowed 19 x a
in the sum of 'Q m
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m w
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o
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CD p
p a n
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0
(Board or Commission) 0
a
FILED (D a
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CD a
(Official Title) p
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A.E. ROYCE CO., INC. MUNCIE, IN 01136 p M
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Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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
Pat v, C cc, Q5 1 c Purchase Order No.
/y3 5 S' am; 1 Po n j S I d Terms
C_o rmed -)nl `4 60 J'� Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Ia Iz ►Zip G ��,NI iG
Total
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.
ALLOWED 20
At 06c,'pS-kLk IN SUM OF
5 rn J) Pn 13
0 --40, /^1e- G, n 3 Z
�-t t
ON ACCOUNT OF APPROPRIATION FOR
arc's L ,3U f7��
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
I tS. 2 materials or services itemized thereon for
which charge is made were ordered and
received except
20
i
Sig ture
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund