163947 09/17/2008 a CITY OF CARMEL, INDIANA VENDOR: 358684 Page 1 of 1
f ONE CIVIC SQUARE SHANNON SHERMAN CHECK AMOUNT: $169.36
%o CARMEL, INDIANA 46032 18816 WIMBLEY WAY
NOBLESVILLE IN 46060 CHECK NUMBER: 163947
CHECK DATE: 9/17/2008
DEPARTMENT ACCO PO NU MBE R I NVOIC E N UMBER AMOUNT D ESCRIPTION
1046 4343000 169.36 TRAVEL FEES EXPENSE
I
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
I r
MILEAGE CLAIM
TO W
AUG 2 7 2008
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(O t
FFICE, BOARD, DEPARTMENT Ofl INSTITUTION)
DATE FROM TO SPEEDOMETER AUTO MILEAGE
RiLADING MILES
+9 POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MILE
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AUTO LICENSE NO. TOTALS
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SPEEDOMETER READING columns are to be used only when distance between points cannot be deteimined 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 lega due, after allowing all 'ust credits
and that no part of the same has been paid.
Date ,r,
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form. 0
That it is duly authenticated as required
by law
That it is based upon statutory authority.
That it is apparently correct
incorrect
On Account of Appropriation No. for Disbursing Officer
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Allowed 19_ M 0 w
in the sum of ,a
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(Official Title) O ID
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A.E. BOYCE CO., INC. MUNCIE, IN 01136 0 z
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. 18564 F
358684 Sherman, Shannon Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/27/08 Reimb. Mileage 7/1/08 8/21/08 169.36
Total 169.36
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.
358684 Sherman, Shannon Allowed 20
In Sum of
169.36
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343000 169.36 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
29 -Aug 2008
J
Signature
169.36 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund