202960 10/25/2011 CITY OF CARMEL, INDIANA VENDOR: 360074 Page 1 of 1
ONE CIVIC SQUARE SUE COY
CARMEL, INDIANA 46032 C/O HUMAN RESOURCES CHECK AMOUNT: $105.12
ONE CIVIC SO CHECK NUMBER: 202960
CARMEL IN 46032
CHECK DATE: 10/25/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4343002 10.21.11 105.12 EXTERNAL TRAINING TRA
Clcum No. Wancmt No. I have examined the within claim and
hereby certify as follows:
IN FAVOR OF
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
On Account of Appropriation No. for
Disbursing Officer
(D
Allowed .20 o a
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in the sum of 0 CQ
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0
(Board or Commission) I a O
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Prescribed by Stale Board of Accounts General Form No 101 (1955)
MILEAGE CLAIM
TO DR.
,mil (Governmental nit)
7 may] On Account of Appropriation No. for (20Y
(Offi Boar epartment or Institution �1p
DATE FROM ebr.u� tr f p s TO Ob t2 ODOMETER READING' NATURE OF BUSINESS AUTO MILES MILEAGE )J
20 Point Point Start Finish TRAVELED PER MILE
eh I i y
1
1fr r
/a 5 Vavz&p� lO
b lUaia� W edf P I
H H
u[ Cl) Ca -f11
4 /7 /-D lad
GUC+cs u /O 5l (Y1t
�a OU
as
Rate 4,c5
s
-7 a s y
7/.-.L (p
7 -r
16 Q V_
Auto License No. TOTALS
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, 1 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. DD
Date
ll
By
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
Purchase Order No.
Term s
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
10/21/11 10.21.11 mileage $105.12
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 NO. WARRANT NO.
ALLOWED 20
Sue Coy
IN SUM OF
$105.12
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1201 10.21.11 43 430.02 $105.12 I 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
(A Monday, October 24, 2011
6L X
Director, HR
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund