202682 10/11/2011 CITY OF CARMEL, INDIANA VENDOR: 361086 Page 1 of 1
ONE CIVIC SQUARE JACOB C MOORE CHECK AMOUNT: $21.22
CARMEL, INDIANA 46032 348 ATHERTON DR
CARMEL IN 46032 CHECK NUMBER: 202682
CHECK DATE: 10/11/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 21.22 TRAVEL FEES EXPENSE
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iRESCRIBEU BY STATE BOARD OF ACCOUNTS
MILEAGE CLAIM JQ." /"`D
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ON ACCOUNT OF APPROPRIATION NO. FOR
(OFP1 B AND, IIEPA NTMtNi Ok iNSCLTU lUK1
AUTO
SPE
iJAT FROM 7'(5 L'DOMETEIi -t,m MILE'S
w HEADING NATURE OF HUSINESS TRAVELED ER MILE
POINT PO START FINISH
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.AUTO LICENSE NO
n distanco between points cawiot be.de(eimiaed by fixed mil eage or official highway Lrap• i ust credits
SPEEDOMETER READING columns are to be Iised only whe
provisions an penalties of C J5S Ac 953 the of that the fOTe oin 'account is just and correct. at th.e giilouiit claimed is legally due, afier al.iowiri
Pursuant to the 9 aI 1
p d p a Chapter is 1 reby ce rtify g g th
and, that no part of the same has been paid,
Date
1 1
I 4
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.
361086. Moore, Jacob Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
9/22/11 Reimb. Mileage 5/6 5/26/11 21.22
Mileage 8/9 9/13/11
Total 21.22
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.
361086 Moore, Jacob Allowed 20
In Sum of
21.22
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -1 Reimb. 4343000 21.22 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
6 -Oct 2011
Signature
21.22 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
ie