177361 09/15/2009 CITY OF CARMEL, INDIANA VENDOR: 359461 Page 1 of 1
ONE CIVIC SQUARE NIKEESHA PITTMAN CHECK AMOUNT: $27.00
CARMEL, INDIANA 46032 2713 HIGHLAND PLACE
N .o INDIANAPOLIS IN 46208 CHECK NUMBER: 177361
CHECK DATE: 9/1512009
DEPARTMENT ACCO P O NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343004 REIMB 27.00 TRAVEL PER DIEMS
FR[SCRI9ED BY 3TA7E BOARD Or ACOOUWn GENrd'AL FORM NO. 101 (19967
MILEAGE CLAIM
ro
VERNl1ENFAL UNIT(
ON ACCOUNT OF APPROPRIATION NO_ FOR t
(pf 'ICE HOARD, DU"T ZHT OR 1Ms CrnrrloN(
SPEEDOMETER
DATE FROM TO READING AUTO MILEAGE
ZD POINT POINT START FINISH NATURE OF BUSINESS TR SS r
PER MILE
]]�L e e t U r 1.0 ss
e+ n I M A4-.-K P- i. 1ct 1 9,0 1
a M a•-t P o E;1 -nAL i En- n
II+
3,, t1 v �I Z `Z e
FMK Ptymr)ct hov, e V
C e �2�2
K tZO Gcp NAW N c f e 'G t' LA r� rte cACD e �txsE I? tlu �kw� 5 o
u� 2 MkG tt5 M �nDN
—aP ft 5G A u t P I Pi Srze O
AUTO LICENSE NO. TOTALS 49
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. 1
P scant 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 I ue, after olio g all just credits
and t t n0 part f the s has bpen paid.
D
AUG 2 8 2009
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.
359461 Pittman, Nikeesha Terms
2713 Highland Place Date Due
Indianapolis, IN 46208
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
8/4/09 Reimb. Mileage 7/2 7/30/09
27.00
Total 27,00
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
I
Voucher No. Warrant No.
359461 Pittman, Nikeesha Allowed 20
2713 Highland Place
Indianapolis, IN 46208
In Sum of
r 27.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 reimb. 4343004 27.00 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
30 -Jul 2009
Signature
27.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I