171836 04/29/2009 CITY OF CARMEL, INDIANA VENDOR: 362827 Page 1 of 1
E ONE CIVIC SQUARE GARY FARSON CHECK AMOUNT: $66.00
CARMEL, INDIANA 46032 9337 HOMESIDE DR
i:o� INDPLS IN 46250 CHECK NUMBER: 171836
CHECK DATE: 4/2912009
DEPARTMENT ACCOUNT P O NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1202 4343002 66.00 REIM
PRESCRIBED BY STATE BOARD OF ACCOUNTS
F.NF.AAi. FORM NO. 101 (1886)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
DATE FROM TO SPEEDOMETER
AUTO MILEAGE
READ
NATURE OF BUSINESS MILES
I'D POINT POINT START FINISH TRAVELED Q
VELED
PER MILE
C I S L' 3 (05
35 LP i7 C.v lit!- 5 3 i f05
CED C dAAAA P XJ C_ ro 5 5
2g is yo
'SzA, LA r r det x %O S SO
U W ATE-k- 17" q q0
4 CFD W 5 N Lk S ''T 1 q 3s
13 5 S C 2- Mk? 5 f7 s 7 70
AUTO LICENSE NO. TOTALS p fp
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 I I b°I
i
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
5� That it is in proper form.
a
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 W a
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Allowed 19 M o a
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in the sum of m
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(Board or Commission) a m
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(Official Title) 0 O
A.E. BOYCE CO., INC. MUNCIE, IN 01136
I'
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))
nA 117 In Q
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 N®W /27109 WARRANT NO.
fi ALLOWED 20
IN SUM OF
$66.00
ON ACCOU &gEAgAL FUND N FOR
1202 Information Systems
Board Members
PO# or
DEPT INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or
202 430 -02 $66.00 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
Si ature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund