178356 10/14/2009 CITY OF CARMEL, INDIANA VENDOR: 360491 Page 1 of 1
ONE CIVIC SQUARE ERIC PURNELL
CHECK AMOUNT: $94.05
CARMEL, INDIANA 46032 12185 PEBBLE 57
UNIT 300 CHECK NUMBER: 176356
FISHERS IN 46038
CHECK DATE: 10/1412009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343004 94.05 TRAVEL PER DIEMS
y
r
PMC&I6ED BY STATE BOARD OF ACCOUNTS GENERAL FOAM NO 101 11466)
L MILEAGE CLAIM
V I i TO
(GOVEANMENTAL UNIT}
ON ACCOUNT OF APPROPRIATION NO. FOR
tOFi1C£, SOAPS, DEPAATMk OR INST=ION)
SPEEDOMETER
D ATE FROM POINT START FINISH I READING AUT
POINT H{ NATURE OF BUSINESS
TAANELEO PER NULE.
AUTO LICENSE NO- TOTALS
SPEEDOMETER READING columns are to be used only when distance between points oannol be determined by fixed mileage or official highway. map.
Pursuant to the provisions and penalties of Chapter lSS, Acts 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed is leg al Wd allowing all just credits
and that no part of the same has been paid.
Date
p�
OCT p 1 2009
J z
PRFSCRIBED BY STATE BOARD OF ACCOUNTS GENFAAL FORM 110. 101 [1986)
MILEAGE CLAIM
TO
t(iovERNlIFNrAL uxlry
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF71CF, BOARD, DEPARTWEV OR INS =LOX)
SPEEDOMETER
AUTO E
FROM TO
AT
2 D I READING f
NATURE OF SUSINE56 MILES Q
POINT POINT START FINISH TRAVELED PER MILE
W
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G Y1 I
l) 0
P
r ti ffiQ[All.$JAI YA V)'M .ry
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I i S
1 J 2o 1 0zA' r i 3
I
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r El? '1 I
oil
Udl
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d
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5
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, I hereby certify that the foregoing account is just and correct, that the amount claimed is legali due, to Bowing all just credits
and that n part of the same has been paid.
Date
'000 0�-
q 7:T1. M
OC T C
L 'Z
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.
360491 Purnell, Eric Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
9130109 Reimb Mileage 8/11 9/30/09 94.05
Total 94.05
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.
360491 Purnell, Eric Allowed 20
In Sum of
94.05
ON ACCOUNT" OF APPROPRIATION FOR
104 Program
PO# or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept
1046 reimb. 4343004 94.05 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
7 -Oct 2009
Lid
�Q
Signature
94.05 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund