205601 01/17/2012 CITY OF CARMEL, INDIANA VENDOR: 364715 Page 1 of 1
ONE CIVIC SQUARE DENEYSE SOLAZZO
s. /o CARMEL, INDIANA 46032 14151 PEPIN PLACE CHECK AMOUNT: $25.53
CARMEL IN 46032 CHECK NUMBER: 205601
CHECK DATE: 1/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 25.53 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORf1 NO. 101 11986)
MILEAGE CLAIM
TO DaVL� �l°�tz
(GOVERNMENTAL UNnI
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFnCE, BOARD, DEPARTMENT OR INSTnIMON)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING
NATURE OF BUSINESS MILES g '�"S r
Z L� POINT POINT START FINISH TRAVELED PER MILE
;cl-- rCC C--r-,k 7M
z I rc M Cc- c o r :s c c :r' cl 5 m:
12 Z S CT ft. o"r v ktes i
CVJ
12 W GNIZ C:--tgc v iCL— i2'c0.f�b v S0
i z `5 Cw I
Ir SO G v.
AUTO LICENSE NO. TOTALS I
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 legally due a, fter allowing all just credits
end that no part of 1 he S me has been paid.
Date �2
(7, qj oo�
JAN 0 4 2012
BY
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.
364715 Solazzo, Deneyse Terms
14151 Pepin PI
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
12130/11 Reimb Mileage 12128 12/30/11 25.53
Total 25.53
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
r
Voucher No. Warrant No.
364715 Solazzo, Deneyse Allowed 20
14151 Pepin PI
Carmel, IN 46032
In Sum of
25.53
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #1TITLE AMOUNT Board Members
Dept
1081 -9 Reimb 4343000 25.53 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
25.53 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund