202747 10/11/2011 CITY OF CARMEL, INDIANA VENDOR: 364943 Page 1 of 1
Q ONE CIVIC SQUARE VICKI RUBIO CHECK AMOUNT: $72.24
CARMEL, INDIANA 46032
CHECK NUMBER: 202747
CHECK DATE: 10/11/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 72.24 TRAVEL FEES EXPENSE
PRFSCMED BY STATE 6OAND OF ACCOU)4n GENERAL FOWL HO. 10) Uws1
MILEAGE CLAIM l 1 l N
ro 1d1C�4�_I I '�._Ntl
(GU- INNENrAL UNi'n
ON ACCOUNT OF APPROPRIATION ND. FOR
(OF. OR INSTCnTrION)
SPEEDOMETER
FROM TO AUTO MILEAGE
I READING NATURE OF BUSINESS MILES 55 .5
lE— r
POINT POINT START FINISH iRRVELEO PER MILE
17 )'A tr? 3
L
9
c7 C1- s
0. 5
G_ C
G
6
C
LA-) o
I' [icy
AUTO LICENSE NO. TOTALS I SO n
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. d
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, l hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing all just credits
end that no part of the same has been paid.
Date
.7
042
y
1AIA
f
ACCOUNTS PAYABL 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.
364943 Rubio, Vicki Terms
.Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
9/30/11 Reimb Mileage 9/6 9/30/11 72.24
Total 72.24
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.
364943 Rubio, Vicki Allowed 20
In Sum of
72.24
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TlTLE AMOUNT Board Members
Dept
1081-3 Reimb 4343000 72.24 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
�,�Ch�pnnrn�
Signature
72.24 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund