205471 01/17/2012 CITY OF CARMEL, INDIANA VENDOR: 365946 Page 1 of 1
ONE CIVIC SQUARE NANCY GOINS
CARMEL, INDIANA 46032 CIO ESE CHECK AMOUNT: $34.96
CHECK NUMBER: 205471
CHECK DATE: 1/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 34.96 TRAVEL FEES EXPENSE
t
PRESCRIBED BY STATE BOARD Or ACCOUNTS GENERAL FORA NO. 10) (1988)
MILEAGE CLAIM
l ro V CC
(GOVERNMENTAL ilNin
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF710E. HOARD. DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAG
E
DATE READING
2 11 POINT POINT START FINISH NATURE OF BUSINESS TRAVEL 55 G r
PER MILE
Gr
5
—Z
t-
t -Z8
i
2- IR
2-
2- I
12.- ILI
AUTO LICENSE NO. TOTALS W� 3q Q r
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. `T
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 leg fly e, after aliowing all just cr 'tr�
end that no part of the same has been paid.
Date t Zt Z0
D eA170 4 101
BYe.....................
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.
Goins, Nancy Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
12/21/11 Reimb Mileage 11/14 12/15/11 34.96
Total 34.96
I 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.
Goins, Nancy Allowed 20
In Sum of
34.96
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -1 Reimb 4343000 34.96 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
11 -Jan 2012
Signature
34.96 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund