161911 07/23/2008 CITY OF CARMEL, INDIANA VENDOR: 359179 Page 1 of 1
ONE CIVIC SQUARE JASON KARSAS
CARMEL, INDIANA 46032 1450 ROYAL LAKE CIRCLE CHECK AMOUNT: $18.12
INDIANAPOLIS IN 46228
CHECK NUMBER: 161911
CHECK DATE: 7/23/2008
DEPARTMENT ACC OUNT PO NUMBE INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343000 18.12 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE HOARD OF ACCOUNTS
GENERAL FORM NO. 101 (1966)
MILEAGE CLAIM
TO
(GOVERNMENTAL uxrr) ON ACCOUNT OF APPROPRIATION NO. FOR f
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER
DATE FROM TO READING AUTO`"` M�IL�EAG�E�----
19 POINT POINT START FINISH
NATURE OF BUSINESS MILES 4
TRAVELED PER MILE
7
V °_✓lA �i�d�,J T .l /ter.. Nr'. i.. S J
IK
1 /ill G�iri1 (J"fJG,'$ l �a.G 'I`aG� t
U
AUTO TOTALS
LICENSE NO. �J �o I
SPEEDOMETER READING columns are to be used only when distance between points, cannot be determined by fixed mileage or official highway map, p�
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 allowing all just credits,
znd that no part of the same has been paid.
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
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in the sum of Er m CD
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(Board or Commission) a m
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AX BOYCE CO., INC. MUNCIE, IN 01136
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.
Karsas, Jason Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoices) or bill(s)) Amount
6/27/08 Reimb Mileage 4/21/08 5/9/08 18.12
Total 18.12
1 hereby certify that the attahced invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Karsas, Jason Allowed 20
In Sum of
18.12
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb 4343000 18.12 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 2007
signature
18.12 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund