167112 12/17/2008 f CITY OF CARMEL, INDIANA VENDOR: 356837 Page 1 of 1
ONE CIVIC SQUARE MICHELLE KRCMERY
CARMEL, INDIANA 46032 433 AUTUMN DRIVE CHECK AMOUNT: $72.25
CARMEL IN 46032
CHECK NUMBER: 167112
CHECK DATE: 1211712008
,5
D EPARTMENT ACCOUNT PO NUMBER INVO NUMBER AMOUNT DESC
''1160 4343004 72.25 TRAVEL PER DIEMS
r—
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM Tj� ��j
To V-le-A Kccmu X 33 RvJ',.f��f rv�t
vt Cs rP,
C�i Ca.rrn�l
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER
DATE FROM TO READING AUTO MILEAGE
NATURE OF BUSINESS MILES
=12, Q Q
�R POINT POINT START FINISH TRAVELED PER M1Lh
2; 4 r
1 5
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AUTO LICENSE NO. TOTALS 37—
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, after allowing all just credits
and that no part of the same has been paid.
Date P2Z{7--&cxDF°
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
correct
That it is apparently incorrect
Disbursing Officer
On Account of Appropriation No. for
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Allowed 19 x x
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in the sum of b x m
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(Board or Commission) O Ef n
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A.E. ROYCE CO., INC. MUNCIE, IN 01136
W 0 L
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Prescrited by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
12 /15/08 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
Michelle Krcmery Purchase Order No.
433 Autumn Drive Terms
Carmel IN 46032 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/12/08 Mileage Log Mileage reimbursement for Michelle Krcmery $62.37
Total $62.37
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
V I DUCHER NO. WARRANT NO.
12/1 5/08
ALLOWED 20
Michelle Krcmery IN SUM OF
433 Autumn Dr.
Carmel IN 46032
ON ACCOUNT OF APPROPRIATION FOR
1160 Mayor 4343004
Travel per diem
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
Mileage LgZ 4343004 bill(s) is (are) true and correct and that the
7a materials or services itemized thereon for
which charge is made were ordered and
received except
20
Si nature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund