173194 06/10/2009 t
CITY OF CARMEL, INDIANA VENDOR: 00350221 Page 1 of 1
ONE CIVIC SQUARE LINDA ACOSTA
CARMEL, INDIANA 46032 C/O PARKS CHECK AMOUNT:
CHECK NUMBER: 1731 173194
a
CHECK DATE: 6/10/2009
DEPARTMENT ACCO UNT PO NUMB IN VOICE NUMBE AMO UNT DESCR
1046 4343004 9.35 TRAVEL PER DIEMS
PUSCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INS TMNON)
SPEEDOMETER
DATT6, FROM TO READING AUTO MILE
NATURE OF BUSINESS MILES va c
POINT POINT START FINISH TRAVELED PEA MI
1 "7 4--
t- :J \CC i
V
AUTO LICENSE NO. TOTALS
O
,44 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 atiowing all just credits
and that no part of the same has been paid.
Date
vj
x-
t�
JUN 0 2 2009 J
L �u
ACCOUNTS PAYABLE 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.
00350221 Acosta, Linda Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
5/30/09 Reimb. Mileage 3/20/09 5/30/09 9.35
Total 9.35
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.
00350221 Acosta, Linda Allowed 20
In Sum of
9.35
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 9.35 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
4 -Jun 2009
Signature
9.35 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund