174852 07/22/2009 CITY OF CARMEL, INDIANA VENDOR: 362827 Page 1 of 1
ONE CIVIC SQUARE GARY FARSON
CARMEL, INDIANA 46032 9337 HOMESIDE DR CHECK AMOUNT: $210.65
INDPLS IN 46250
CHECK NUMBER: 174852
CHECK DATE: 7/22/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1202 4343002 210.65 EXTERNAL TRAINING TRA
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1886)
MILEAGE CLAIM
E—Lr TO
(GOVERNMENTAL UNIT)
T ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
D ATE R NATURE OF BUSINESS MILES 55 Q
POINT POINT START FINISH TRAVELED PER MILE
al mac, 3 i �s
y
99 c o,�n,v� cT�,e $Ro s /0 5 5a
2 3 F 1 -4 W 0
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97 wA r�� a 65
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AUTO LICENSE NO. TOTALS `3S
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 a ll just credits
and that no part of the same has been paid.
Date —7 I G I
"Form
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form.
Clr�r t.7 l.l� �.C 7 Y 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. MUNCIE, IN 01136 W 0
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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
Gary Farson Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
0710 Mileage $210.65
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 IQd �20109 WARRANT NO.
F arqnn
ALLOWED 20
IN SUM OF
$210.65
ON ACCOI Ytgt pgpg WION FOR
1202 Information Systems
Board Members
POT INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or
30 -02 $210.65 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
Signa�4
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund