161874 07/23/2008 CITY OF CARMEL, INDIANA VENDOR: 361054 Page 1 of 1
ONE CIVIC SQUARE CHARLES A IMAN
CARMEL, INDIANA 46032 12525 OLD MERIDIAN ST APT 317 CHECK AMOUNT: $91.91
CARMEL IN 46032 CHECK NUMBER: 161874
Gr co
CHECK DATE: 7/23/2008
DEPARTMENT ACCOUN P O NUMBER INVOICE NUMBER AMOUNT D ESCRIPTION
1046 4343000 91.91 TRAVEL FEES EXPENSE
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PRESCRIBED BY STATE BOARD OF ACCOUNTS F :,GENERAL F.ORM-NO. 101 (1986)
MILEAGE CLAIM
TO JUL fl 8 2nnR
OVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR I
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILE AGE
DATE READING
NATURE OF BUSINESS MILES S c
19 a T POINT START FINISH TRAVELED
PER MILE
a 4. r C ,K .N"" wa
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AUTO, LICENSE NO. NY bay p�rr,� 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, of r owing all just credits
lend that no part of the same has been paid.
'Date
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.
Iman, Charles Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/27/08 reimb. Mileage 4/8/08 5/16/08 91.91
Total 91.91
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
i
Voucher No. Warrant No.
Iman, Charles Allowed 20
In Sum of
91.91
ON ACCOUNT OF APPROPRIATION FOR
104 Program
or
Board Members
Dept INVOICE NO. ACCT #/TITLE AMOUNT
1046 reimb. 4343000 91.91 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
17 -Jul 2008
Signature
91.91 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund