177677 09/29/2009 CITY OF CARMEL, INDIANA VENDOR: 355994 Page 1 of 1
ONE CIVIC SQUARE PAMELA GRIFFITHS
CARMEL, INDIANA 46032 12906 DOUBLE EAGLE DRIVE CHECK AMOUNT: $68.48
CARMEL IN 46033 CHECK NUMBER: 177677
CHECK DATE: 9/29/2009
DEPAKT ACCOUNT PO NUMBE INVOICE N UMBER AMOUNT DES CRIPTION
1202 ^4343002 68.48 EXTERNAL TRAINING TRA
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM C I
TO
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER
FROM TO ATO MILEAGE
DATE READING
LES 19 POINT POINT START FINISH NATURE OF BUSINESS F TRAUELED
PER MILE
I R bide Coli QU re- C14 C66C i 1 5 VLF ry Gc71 f- 0 0 :4 1 -D
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3
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09 Sa' r
AUTO LICENSE NO. TOTALS C
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, after allowing all just credits
and that no part of the same has been paid.
Date I a
Claim No. Warrant No. T have examined the within claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form.
That it is duly authenticated as required
by law
That it is based upon statutory authority.
That it is apparently correct
incorrect
a. 176
Disbursing Officer
On Account of Appropriation No. for
o b' w
ts y
fD N
p A
Allowed 19� n a
n a
CD K m
in the sum of
co a.
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m
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a. n
0
o'4:
(Board or Commission) 0 14
d
m gL a
FILED
w a
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(Official Title) o.—
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A.E. BOYCE CO., WC. NVNCIE, W GI 136 0
I'
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM Nm 1� 1 F P 1 y
Ac) rnIN TO
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING F NATURE OF BUSINESS TRAVELED
19 5
POINT POINT START FINISH PER MILE
4 l7 G� l -1��5 PL 7 LD G L 'b %D 2 i;rL
J 9 11 o' 14 PL mT t fti r! G
Q q l- T1- 9i xi e 71
4 J o A A qjeof em i v L
I g v E U� c �f u rJ -0 -t I a a I ft 12
B i14 L r- So p S u
c oq 0 C;V b A 1.1 cccc- I �hTl�vG- o IJ
3 i; uJ O ii Ci /11- r CLN Hcwt. J
2 04 1 Ne C IV I G A66 C, H G 6 C- i 1T; G n rr10 dh AR4
w G O.' 6CV►L e Cc, 6
a c 11 I t.J a+l'� re D eJ rX1 G C, i
0 I i ee OIJ E Q ui c. 5 aL4 C,- 6AA F46L'ik' G% I
a 0 I Q(\)G L i d 10 (Oj G'vl L i C i
+7 0
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a q vci -C �h 6t1
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o wi a 51% -1 C, Lc 6 Vat-e- H at.
aW
5 6 TOTALS
S
AUTO LICENSE NO.
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 1 after allowing all just credits
and that ng part of the same has been paid.2��C
Date
4r,
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form.
That it is duly authenticated as required
by law
That it is based upon statutory authority.
correct
That it is apparently
incorrect
Disbursing Officer
On Account of Appropriation No. for
o tr w
p p
m
Allowed 19_ x 0 rt
ID
a cD
in the sum of m
w
c� tr•
ID
tD m 0
P.
H (D
(D Q+
p a A
O
n m
(Board or Commission) O O
G. CD
a
p
FILED m
y
tr d
w_ a
ra
w m
(Official Title) 0 o
o.tr'C
ro
ro
A.E. EOYCE CO., INC. MUNCIE, IN 01M
10
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Feu. 1995)
CITY OF CARMEL
An invoice or 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
Pam Griffiths Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
009117/01) Mileage $29.70
09/17M M o lea—ge $38.78
Total
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 N0 9/28 /09 WARRANT NO.
Pa ii
ALLOWED 20
IN SUM OF
$68.48
ON ACCOUI`69� �AOFUN I FOR
1202 Information Systems
Board Members
P09 or
DEPT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
1202 430 -02 $68.48 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
20
-Sig ture
vd Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund