177196 09/15/2009 CITY OF CARMEL, INDIANA VENDOR: 362827 Page 1 of 1
0 ONE CIVIC SQUARE GARY FARSON CHECK AMOUNT: $123.30
CARMEL, INDIANA 46032 9337 HOMESIDE DR
INDPLS IN 46250 CHECK NUMBER: 177196
CHECK DATE: 9/15/2009
DEPA RTMENT A CCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1202 4343002 123.30 EXTERNAL TRAINING TRA
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
TO `7Q�J �^�SC�/�
1
(GOVERNMENTAL N
ON ACCOUNT OF APPROPRIATION NO, FOR
OF I E, BOA DEPARTMENT OR INSTITUTION)
SPEEDOMETER AUTO MILEAGE
DATE FROM TO READING NATURE OF BUSINESS MILES (off S
18' POINT POINT START FINISH TRAVELED PER MILE
•q !1
44�
7 f
041 Je /5
v
S
G E
n
AUTO LICENSE NO. TOTALS U r
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 legally due, after allowing all just credits
and that no part of the same has been paid.
Date U
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 I correct
l incorrect
Disbursing Officer
On Account of Appropriation No. for
o tra
p p
0
o 9 :i m
y `ri C1
Allowed 19_ o w 0 a
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in the sum of b
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(Board or Commission) o n
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W
A.E. BOYCE CO., INC. MUNCIE, IN 01136
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORM N (1 986)
MILEAGE CLAIM
TO T�
(GOVERNMENTAL UN ON ACCOUNT OF APPROPRIATION NO. FOR
OFFICE BOA AD, D ARTMENT OR INSTITUTION)
DATE
FROM TO SPEEDOMETER AUTO MILEAGE
READING
�4 POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MILE
L
7'1
L' �f—
IV I
s�
U r�
L�
T
1�
n
T
AUTO LICENSE NO. TOTALS Qp
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 legally due, after allowing all just credits
and that no part of th same has been paid.
Date
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,
f correct
That it is apparently 1 incorrect
Disbursing Officer
On Account of Appropriation No. for
o tT a
Q+ t Q
(D
n y
M p n
Allowed 19_ 0 a
in the sum of m
rn
m a tr
CL
,a m
F-+ y
0
m
a
p A. o
a o
0
(Board or Commission)
PL m
a
m
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tv p
rt n
m w a
Of ial Title) o o I
e 0
a
M
A.E. BOYCE CO., INC. MUNCIE, IN 01136 0
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
TO
et
G ERNE AL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, OA�AR ENT OR INSTITUTION)
DATE FROM TO READING SPEEDOMETER AUTO MILEAGE
NATURE OF BUSINESS
POINT POINT START FINISH TRAVELED
PER MILE
C 1 G G id
r Vo n c
I 41
f
n
AUTO LICENSE NO. TOTALS v
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 accoui}t is just and correct, that the amount claimed is legally due, after allowing all just credits
and that no part of the same has been paid.
Date 5a�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
o rr' a
r p p
:e y MO 0
n N
a�
Allowed 19_ (D x a
m 'k'
in the sum of m
a
y (D
p G. n
O
A
(Board or Commission) O A
a (D rt
a
FILED a Q.
y
a a
Official Title) O 0 W
o
C N m
R'
A.E. BOYCE CO., INC. MUNCIE, IN 01136 kQ 0
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
G ary Farson Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
09/01/0 Mileage
Total
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 N09 /14/09 WARRANT NO.
ALLOWED 20
esl a Drive IN SUM OF
Indianapolis, IN 46250
$123.30
ON ACCOUNzeQPP FUND N FOR
1202 Information Systems
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1202 430 02 $123.30 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
20
)Sign to
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund