156823 02/21/2008 CITY OF CARMEL, INDIANA VENDOR: 360411 Page 1 of 1
ONE CIVIC SQUARE- AARON SMITH
CARMEL, INDIANA 46032 9773 SAN MARCO PASS CHECK AMOUNT: $76.53
INDIANAPOLIS IN 46280 CHECK NUMBER: 156823
CHECK DATE: 2/21/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343000 76.53 TRAVEL FEES EXPENSE
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PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORM NO. 101 (1966)
II
kzu I D `1.. MILEAGE CLAIM nn JAN 1 8 200
DEPT TO—
(GOVERNMENTAL UNIT)
I 11 ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION) DE U SC T�aVel Fees
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING NATURE OF BUSINESS MILES 0
POINT POINT START FINISH TRAVELED PER MILE
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AUTO LICENSE NO. TOTALS 1 5
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 1''e9 due, alter allowing all just credits
and that no part of the same has been paid.
Date /b6
i
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,
That it is apparently correct
incorrect
Disbursing Officer
On Account of Appropriation No. for
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A.E. BOYCE CO., INC. MVNCIE, IN 01136 t Q+
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.
Aaron Smith Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/17/08 reimb. mileage reimbursement 76.53
Total 76.53
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Aaron Smith Allowed 20
In Sum of
76.53
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 reimb. 4343000 76.53 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
13 -Feb 2008
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Sig tur
76.53 Business Sery Manager
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund