202585 10/11/2011 CITY OF CARMEL, INDIANA VENDOR: 125575 Page 1 of 1
ONE CIVIC SQUARE MIKE HEINZMAN
CARMEL, INDIANA 46032 CHECK AMOUNT: $10.21
C/0 COMM CNTR
o� C/0 COMM CNTR CHECK NUMBER: 202585
CHECK DATE: 10/11/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1115 4343004 10.21 TRAVEL PER DIEMS
I
Prescribed by Sate Board of Acccun!s General Form No.G 1 955;
MILEAGE CLAIM
TO �civ�d i�, �L�n2ma/t DR.
(Governmental Unit)
On Account of Appropriation No. for
(Office, Board. Departrnen! or InstituUon)
DATE FROM TO
ODOMETER READING' NATURE OF BUSINESS 1 I AU I V MILES MILEAGE
20 I Point Point Start Finish TRAVELED PER MILE
5 golf r C- G e, I e SS I II I
3 I I T V KI
G 03 h S e- Z C-M 1; c0--
r m e-
C t
A rme, a L4
N e-r'e o
14 Y 2 S VJ C4/'M e l
e e rc w fil Ck
n G au
f I
GCS
i
Auto license N o: TOTALS I !D
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 cl e" d is legally due, after
allowing all just credits, and that no part of the same has been paid. r
Date o T
i
Clam No. Wczrrant No. I have examined the within claim and
hereby certify as follows:
IN FAVOR OF
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 Jj cones
1 incorrect
On Account of Appropriation No. for
Disbursing Officer
t3 R m
Allowed .20 (D n o
0
in the sum of o P
"CD ��P
CD
to CD 0
(Board or Cornrnm n) I R O
m
FH rt
l tr
CD
0(D
CD
c
(Official Title) G CD
N O
0 c R.
VO UCHER N WARRANT NO.
ALLOWED 20
Mike Heinzman
IN SUM OF
18934 Planer Drive
Noblesville, Indiana 46062
$10.21
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO# Dept. INVOICE NO. I ACCT #/TITLE AMOUNT Board Members
1115 I I 43- 430.04 I $10.21 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
Monday, October 10, 2011
-C\
Director
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or 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.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
10/05/11 $10.21
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