161930 07/23/2008 CITY OF CARMEL, INDIANA VENDOR: 356917 Page 1 of 1
ONE CIVIC SQUARE MELANIE LENTZ
0 CARMEL, INDIANA 46032 8440 E 131ST STREET CHECK AMOUNT: $43.93
FISHERS IN 46038 CHECK NUMBER: 161930
CHECK DATE: 7/23/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1160 4343004 43.93 TRAVEL PER DIEMS
�3 y3 o Y
PRESCRIBED BY STATE BOARD OF ACCOUNTS 7
GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRItinUN NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION
SPEEDOMETER
DA TE FROM TO READING AUTO MILEAGE
NATURE OF BUSINESS MILES
POINT POINT START FINISH TRAVELED PER MILE
Lo- An a a t
ON 10 r�
c LA Q
,U .7 s K
Lyd
11 Asa
Ci r L"? di
1( Y A 1
f)8r,�rJA Q C.i t I -F i s s OR
�S Lk
AUTO LICENSE NO. TOTALS
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined bv. 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 1 g ,lly ue, after aliowing all ju t redi s
and that no part of the same has been paid.
i, Date 7 j 7 09 W
r.
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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A.E. BOYCE CO., INC. MUNCIE, IN 01136
Pres -rih d by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
7/21/08 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.
One Civic Square Terms
Carmel IN 46032 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
7/17/08 Mileage Log, Milea e reimbursement for Melanie Lentz to perform $43.
city business
Total $43.93
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
VOUCHER NO. WARRANT NO.
7/21/08
ALLOWED 20
1
Melanie Lentz IN SUM OF
One Civic Square
Carmel IN 46032
43.93
ON ACCOUNT OF APPROPRIATION FOR
1160 Mayors 4343004
Travel per Diem
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
ilea e Lot 4343004 $43.93 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
Signatu�e��
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund