166891 12/10/2008 CITY OF CARMEL, INDIANA VENDOR: 358684 Page 1 of 1
ONE CIVIC SQUARE SHANNON SHERMAN CHECK AMOUNT: $112.91
CARMEL, INDIANA 46032 18816wIMBLEVWAY
o� NOBLESVILLE IN 46060 CHECK NUMBER: 166891
CHECK DATE: 12/10/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343000 REIMB 112.91 TRAVEL FEES EXPENSE
E
E
z
P
PRESCRIBED BY STATE BOARD OF ACCOUNTS GrNERAL FORM 110. 101 (1980
MILEAGE CLAIM S-
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER
DA�TE� FROM TO I READING AUTO MILL- EcA�GE-
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED s R
PER MILE
/F O 1 7 1
Gj2
ot 04 C41 1
e.t
r d o i
a/ S
,ell H
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. VVV
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 ftll ju st credits
and that no part of the same has been paid.
Date
i
DEC 0 1 2008
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.
358684 Sherman, Shannon Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/25/08 Reimb. Mileage 10/20/08 11/24/08 112.91
Total 112.91
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.
358684 Sherman, Shannon Allowed 20
In Sum of
112.91
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343000 112.91 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
1 -Dec 2008
Signature
112.91 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund'