164812 10/16/2008 CITY OF CARMEL, INDIANA VENDOR: 356917 Page 1 of 1
ONE CIVIC SQUARE MELANIE LENTZ
CARMEL, INDIANA 46032 8440 E 131ST STREET CHECK AMOUNT: $24.65
FISHERS IN 46038 CHECK NUMBER: 164812
CHECK DATE: 10/16/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUM AMOUNT DESCRIPTION
1160 4343004 24.65 TRAVEL PER DIEMS
y3 V300 y
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
To �1a�� P 4,V1 U d L' 3 I S, h i �U D 7 S
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
DATE FROM TO SREEDOMGET +R
AUTO LEA
NATURE OF BUSINESS MILES Q c 0
POINT POINT START FINISH TRAVELED PER MILE
•k i4n 7 r)
5 S I 5�
Ohl "�o r
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Se i s C� G1� r Upon C o' rv'. t q C0
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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 fter allowing all just redits
and that no part of the same has been paid.
Date 0A_Dt
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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Allowed 19 M a
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in the sum of M
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(Board or Commission) O
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A.E. BOYCE CO., INC. MUNCIE, IN 01136 0 z
Prescrib,d by ACCOUNTS PAYABLE VOUCHER
State Board of Accounts City Form No. 201 (Rev. 1995)
10/13/08 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
Melanie Lentz Purchase Order No.
8440 E. 131st St. Terms
Fishers, IN 46038 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
10/10/03 Mileage L Milea e for Melanie Lentz $24.65
Total $24.65
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
UCHER NO. WARRANT NO.
ALLOWED 20
Melanie Lentz IN SUM OF
8440 E. 131st st.
Fishers IN 46038
24.65
ON ACCOUNT OF APPROPRIATION FOR
1160 Mayors 4343004
Travel per Diem
Board Members
PO#
EP or
EPT. INVOICE NO. ACCT #/TITLE AMOUNT
D I hereby certify that the attached invoice(s), or
Mileag Log 4343004 $24.65 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
�Signa ure
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund