161944 07/23/2008 CITY OF CARMEL, INDIANA VENDOR: 361563 Page 1 of 1
Is s< ONE CIVIC SQUARE ADELE MARRS CHECK AMOUNT: $43.83
CARMEL, INDIANA 46032 1112 N COLLEGE AVE #105
"yo? INDIANAPOLIS IN 46202
o CHECK NUMBER: 161944
CHECK DATE: 7123/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343000 43.83 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL- FORM.NO._101_.(198
MILEAGE CLAIM
TO I 1
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER
DATE FROM TO READING AUTO MILEAGE
NATURE OF BUSINESS MILES S U S
19 POINT POINT START FINISH TRAVELED
PER MILE
fr G Ively T
y
U Iv 6- /V P v
r 66 JZ 6yA-1SfN Z
loy C I Z H rq x. LIZ 1�0 r
L2G I SHWIALy o Z CL t1,��
M i 712 ,HOCL r 96616 n4 Z
M61V !V f/
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h 00tk7hJ
ru0 rl/ y
ZI I M l`261L� i�YV TIZAI/t/�i�
iv a
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wr orvaN ,r
G h/ d Af D
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 legall y due, after allowing all just credits
land that no art of the same has been paid.
Da €e (17 A5
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
G p
N O�
y M
Allowed 19_
Er-
in the sum of 'd
M
CD 9U tr
CD W E
0
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a a
0
a 1
(Board or Commission) 0 5 a
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FILED CD
IV.
(Official Title) o M
A ROYCE CO., INC. MUNCIE, IN 01136 O tv
ACCOUNTS PAYABLE VOUCHER
j 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.
Terms
Marrs, Adele
Date Due
Invoice Invoice Description
or note attached invoice(s) or bill(s)) Amount
Date Number 43.83
6/27/08 reimb. Mileage 5/7/08 6/3/08
Total 43.83
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.
Marrs, Adele Allowed 20
In Sum of
43.83
ON ACCOUNT OF APPROPRIATION FOR
104 Program
PO# or INVOICE NO. ACCT WTITLE AMOUNT Board Members
Dept
1046 reimb. 4343000 43.83 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
18 -Jul 2008
Signature
43.83 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
i
5