179378 11/11/2009 CITY OF CARMEL, INDIANA VENDOR: 362099 Page 1 of 1
ONE CIVIC SQUARE KIM PREUSCH
0 CHECK AMOUNT: $103.95
CARMEL INDIANA 46032
1530 DEERFIELD DRIVE
PLAINFIELD IN 46168 CHECK NUMBER: 179378
CHECK DATE: 11/11/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343004 103.95 TRAVEL PER DIEMS
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
ec MILEAGE CLAIM -Preoch
TO--
R
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
TION)
(OFFICE, BOARD, DEPARTV es TE-E
MTT-IM INSTITU
SPEED
DATE FROM TO 1, I READIN M G AUTO MILEAGE MILES E7ER 1 C
NATURE OF BUSINESS MILES
POINT TRAVELED 1;
POINT START FINISH PER MILE
VA C VX 0 0 A I Z""
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AUTO LICE 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 I gally due, after al'7 just credits
end that no part of the e has been paid. r J
Date
G2 Le 9 7J I
OCT 3 0 2009 CL,
lay
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
t Purchase Order No.
Preusch, Kim Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
10129/09 Reimb. Mileage 9/21 10/28/09 103.95
Total 103.95
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.
Preusch, Kim Allowed 20
In Sum of
103.95
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 103.95 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
5 -Nov 2009
Signature
103.95 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund