167880 01/21/2009 CITY OF CARMEL, INDIANA VENDOR: 00350221 Page 1 of 1
ONE CIVIC SQUARE LINDA ACOSTA CHECK AMOUNT: $7.02
CARMEL, INDIANA 46032 C/O PARKS
oar CHECK NUMBER: 167880
CHECK DATE: 1/21/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343000 7.02 TRAVEL FEES EXPENSE
r,
I
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (7966)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT1 T
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTbCEMrT OR INSTETUTiON)
D FROM TO I S EADDI G f AUTO ldILEAZE
Z° NATURE OF BVSINE55 POINT POINT START FINISH TRAV£ ED Q
PEA MILE
I T
k
y
AUTO LICENSE NO. TOTALS
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or ollicial highway. map.
Pursuant to the provisions and,penalties of Chapter 155, Acts 1353, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, a ter aliowfng al just ere its
"'and that no part of the same h been paid.
Date 1
i "WF1
JAN 0 5 2009
7 NT,
3 is
r
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)) Amount
12/12/08 Reimb. Mileage 12/12/08 7.02
Total 7.02
I hereby certify that the attached invoice(s), or bills) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
,20
Clerk- Treasurer
A
Voucher No. Warrant No.
00350221 Acosta, Linda Allowed 20
4
In Sum of
P'•
7.02
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #!TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343000 7.02 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
6 -Jan 2009
Signature
7.02 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund