165428 10/29/2008 CITY OF CARMEL, INDIANA VENDOR: 358684 Page 1 of 1
ONE CIVIC SQUARE SHANNON SHERMAN CHECK AMOUNT: $159.12
CARMEL, INDIANA 46032 18816 WIMBLEY WAY
NOBLESVILLE IN 46060
CHECK NUMBER: 165428
CHECK DATE: 10/29/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343000 159.12 TRAVEL FEES EXPENSE
Vii'
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NG. 101 (1986)
MILEAGE CLAIM
(GOVERNMENTAL UNIT) ON AC COUNT OF APPROPRIATION NO. FOR
(OFi10E, BOARD, DEPARTMENT OR 1NMTrUr)ON)
SPEEDOMETER AUTO MILEAGE
FROM TO I READING
DATE POINT POINT START FINISH NATURE OF BUSINESS MILES p j�, S
X TRAVELED
W
cnc•2. c� ools� c0
c 7 O S U L• c +v
421 c 1 c U S e�—
of 7 61 rrc P
33
ox� U 3 C
a •'b L.c:J C y3(v iu?.� �ytz �-,.•r c f-:`;,ai
J
D 7 r"
v zy 17a
4Y7.0. 7
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.
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 isle lly due, after alio� all ju cledits
and that no part of the saa)me as been paid.
Date 0 f V
f e--, tyTv
ti 9 ;Z008
B i�
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
10/14/08 Reimb. Mileage 8/26/08 10/14/08 159.12
Total 159.12
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
159.12
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
Dept
1046 Reimb. 4343000 159.12 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
20 -Oct 2008
Signature
159.12 Accounts Payable Coordinat
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund