162571 08/14/2008 CITY OF CARMEL, INDIANA VENDOR: 065950 Page 1 of 1
ONE CIVIC SQUARE DIANA CORDRAY CHECK AMOUNT $258.22
CARMEL, INDIANA 46032 11843 STONEY BAY CIRCLE
CARMEL IN 46033-9501 CHECK NUMBER: 162571
CHECK DATE: 8/1412008
DEPARTMENT .w ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4343004 241.72 MILEAGE
1701 4343004 16.50 PARKING
Ive=ihad b7 Sim. Boctd a: M -0=t
^iaa U al Farr No. EQI Cl**�
MILEAGE CLAIM
(GOVERNMENTAL UNIT) TO DR.
ON ACCOUNT OF APPROPRIATION N0. FO
{OPFECE. BOARD. DEPARTMENT OR INSTITUTION)
DATE FROM T O SPEEDOMETER AUTO MI
1� READING+
POINT NATURE OF BUSINESS MILES
POINT START FINISH TRAVELED PER MILE
UL II V r C I 1.
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AUTO LICENSE NO. TOTALS
+SPEEDOMETER READING colurnns 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 =d correct. that the amount claimed is legally due. after allowing. all just creel
and that no p f the same has been paid.
Date
Claim No. Warrant No. I have exerrmined the.wi- tiain..ciaim and.hereby
w.... certify as follows;
IN FAVOR OF
That it is in proper dorm
That it is -duly authenticated as required
by law.
That it is based upon statutory authority.
That it is appe?rentiy t correct
i
incorrect
2 P e 1. J
On Account of Appropriadcn' No, for Dis urs2ng Of cer
C a
4
Ahowed 19. CD rn Q
in the sum of q r
o a`
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q
0 O CD
(Board or Commission) x
ro cD p
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0
Co
FILED a
(Official Title)
Q p Q
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e. 6. BONG[ CO.. M17rc C1l, IMO- 96777 n .3
h�cibed b7 9t-L- 13 a d o: Arno m
,^,m erd Forces No. 101 Ll eae
MILEAGE CLAIM
(GOVERNMENTAL NIT] TO
DR.
ON ACCOUNT OF APPROPRIATION N0. FO
{OFFICE. BOARD, DEPARTMENT OR INSTITUTI
DATE FROM TO SPEEDOMETER I AUTO M A tE
READ[NCs+ MILES
POINT POINT
START FINISH NATURE OF QUSINESS TRAV EI—ED PER MILE
r I I
i
E t t I 1
I
I
I I
i
t
i I
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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 creel
and that no art of the same has been paid.
Date 5
Ciaira No. Warrant Na [have exainineci the witt�in.claisn and hereby
certify as i fdilows:
IN FAVOR OF
That it is�'in, proper 'form.
Thc3t. it is j duly autYrea-ticated as required
by law.
Tnat -it is based upon statutory authority.
1
That it is apparently, correct incorrect
On Account of Appro riation No for i7is using Officer
G p a CD L06
CD
CD
Allowed 19 a C
0
o Q
in the sum of
o m 0
CD M Q
(Board or Commission) x
D n
Q O
f] 0 n
FILED a
w
cD EP
(Official Tftle) Q
Q C O
r, p QQ
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A.E. BOYCE CO.. MUNCIE. IND. 010i10 n
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
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.
1 a V owl i—&] ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoices 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
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund