160945 06/25/2008 CITY OF CARMEL, INDIANA VENDOR: 356837 Page 1 of 1
ONE CIVIC SQUARE MICHELLE KRCMERY CHECK AMOUNT: $158.57
%a CARMEL, INDIANA 46032 433 AUTUMN DRIVE
CARMEL IN 46032 CHECK NUMBER: 160945
CHECK DATE: 6/25/2008
DEPARTMENT ACCOUNT PO N UMBER INVOICE NU MBER AMOUNT DESCRI
1160 4343004 158.57 TRAVEL PER DIEMS
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PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
(r, c To c�h �1 K r e r y?�� r, r L a m e 717 `Lq J L h
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER
DATE GG FROM TO READING NATURE OF BUSINESS M ILES MILEAG
S p 5 a
'Q� POINT POINT START FINISH TRAVELED PER MILE
I
2
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A-k Q 5
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l to Sew s Ilk d'yl
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AUTO LICENSE NO. TOTALS 1 2— 0 I
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. l
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, after allowing all just credits
and that no part of the same has been paid.
Date
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 1 correct
1 incorrect
Disbursing Officer
On Account of Appropriation No. for
o tr a
O O SOD
y
v a
Allowed 19 m Q w
ti rtw s-
in the sum of o
m co
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(Board or Commission) O n
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FILED c
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(Official Title) O ti
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A.E. BOYCE CO., INC. MUNCIE, IN 01136 P. Q.
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PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FOAM NO. 101 (1986
MILEAGE CLAI
cf Ca r rn e( To U �3 f-�-� m >1� r Ca r nne� =N �l�
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
DATE FROM TO SPEEDOMETER AUTO
READING MILEAGE
MILES �j C 5
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED PER MILE
2 4 5
sn
S
S
5 2
n n S
2-3 KLFIX-n cc
3�
3 M
i ec
OWN 11 -hkt
AUTO LICENSE NO. TOTALS 5Z-
1
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. "3 11 1 5
Pursuant to the ro_visions 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, aliowin all just cre
P P P Y Y g g g Y g J
and that no part of the same has been paid. r _A
Date
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
3 That it is in proper form.
k That it is duly authenticated as required
z by law
That it is based upon statutory authority.
That it is apparently correct
incorrect
Disbursing Officer
On Account of Appropriation No. for
o tr a
a m o
y c
M 0 n
Allowed 19 A a 0 a
(D
in the sum of
K., m a
m m
a
Yn
C�
a
CD
Q. o
O `e
(Board or Commission) o n
lal C rt
a
FILED (D
a
W a
y
(Official Title) O
0
C (D rt
t3r' r4
F' d
A.E. ROYCE CO., INC. MUNCIE, IN 01136 4 0
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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
Purchase Order No.
P yA urn V-e-- Terms
6 ,Z N L k bC�32 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
0
Total 5 r j
I 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.
ALLOWED 20
1"IIC�� �'('C"h�•P IN SUM OF
s.
ON ACCOUNT OF APPROPRIATION FOR
q� 4 �>O vL(
f
Board Members
DE a INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or
L} 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
TSignat}ore�
l dvl
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund