155377 01/10/2008 CITY OF INDIANA VENDOR: 355133 Page 1 of 1
ONE CIVIC SQUARE AUDREY B KOSTRZEWA
CARMEL, INDIANA 46032 2592 TURNING LEAF LANE CHECK AMOUNT: $198.70
CARMEL IN 46032 CHECK NUMBER: 155377
CHECK DATE: 1/10/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4343000 198.70 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORb�NO. 101 (1986)
MILEAGE CLAIM
2007 f TO 1� S !2
(G vER I NTALL UNLIT) I ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, B RD, DEPARTMENT OR INS TUTION)
FROM TO SPEEDOMETER L 3 AUTO MILEAGE
DATE
READING NATURE OF BUSINESS MILES 0
POINT POINT START FINISH TRAVELED PER MILE
UA/
Jv
lr t>
AJ
WW
i'
AUTO LICENSE NO. TOTALS �O 9 /C�B 7 0
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, 1 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
2007 MILAGE Audrey Kostrrewa
From Admin to Bank to City Hall to From Admin to CityHall From Admin to From Admin to From Admin to Central From Admin to
TRIPS Admin to Admin Rec Office to Clay Twp to Admin Pk to Admin Monon Cntr
Admin (one way) Total Miles
2.2 miles 1.8 Miles 2.8 miles 4 miles 2.3 miles 1.1 miles for Month of of of of of of of of of of #o
f of
Dates trips miles Dates trips miles Dates trips' miles Dates trips j miles Dates trips miles Dates trips miles
2- 3- 4- 5- 8- 9- 10- 11 -12 -16
JAN 17- 18- 19- 22- 23- 24 -25- 21 46.2 4 -5 -18 3 8.4 9 1 4 58.6 JAN
26- 29 -30 -31
1-2-5-6-7-8-9-12- 13 -14-
FEB 15- 16- 17- 18- 19- 20 -21- F22 48.4 9 -15 1 2.8 15 1 4 55.2 FEB
22- 23- 26 -27 -28
1-2-5-6-7-8-9-12- 13 -14-
MAR 15- 16- 19- 20- 21- 22 -23- 22 48.4 12 1 1.8 9 -15 -29 3 8.4 13 1 4 62.6 MAR
26- 27- 28 -29 -30
APR 2 -9- 122 616 -23- 6 10.8 6 -12 -26 3 8.4 10 1 4 6 1 2.3 25.5 APR
MAY 7 -10 -24 3 5.4 4 1 2.8 8 -22 2 8 4- 10- 15 -17- 8 18.4 34.6 MAY
25- 29 -30 -31
JUNE 4- 7 -18 -21 4 7.2 12 -26 2 8 1- 4- 5- 6 -7 -8- 10 23 26 1 1.1 39.3 JUNE
11- 12 -20 -28
2-3-11-17
JULY 2- 5- 16 -19 -30 5 9 10 -24 2 8 23- 24 -25 -26 9 20.7 10 -24 2 2.2 39.9 JULY
27
AUG 9- 6- 7- 9 -13 -15 10 18 14 -28 2 8 3- 7- 15 -21- 6 13.8 14 -28 2 2.2 42 AUG
16- 23 -27 -30 24 -30
SEP 13 -24 2 3.6 11 -25 2 8 7- 11 -18 -26 4 9.2 11 -25 2 2.2 23 SEP
OCT 8- 11 -22 -25 4 7.2 9 -23 2 8 9 -23 2 2.2 17.4 OCT
NOV 5 -8 -16 3 5.4 12 1 4 13 -27 2 2.2 11.6 NOV
TOTALS 143.0 68.4 30.8 1 87.4 12.1 1 409.7
GRAND TOTAL 409.7 miles $.485 /mile $198.70
L
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
xwhom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Audrey Kostrzewa Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/29/07 reimb. Mileage reimbursement 198.70
Total 198.70
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.
Audrey Kostrzewa Allowed 20
In Sum of
198.70
ON ACCOUNT OF APPROPRIATION FOR
101- General Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 reimb. 4343000 198.70 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
4 -Jan 2008
Signature IJftti
198.70 Business ervlces ana
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund