179631 11/24/2009 CITY OF CARMEL, INDIANA VENDOR: 360417 Page 1 of 1
ONE CIVIC SQUARE JESSICA DAVIS
CARMEL, INDIANA 46032 CHECK AMOUNT: $28.05
CHECK NUMBER: 179631
CHECK DATE: 11/24/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343004 REIMB 28.05 TRAVEL PER DIEMS
r`
PRESCRIBED 87 STATE BOARD Of ACCOUNTS
GERF.RAL FORM IIG. 101 1198
MILEAGE CLAIM
TO
CAIZIV�� L LAS f �1t Ott P.�JD �'�EGQEA7'lU�l
(aovERHwulrAi,v1+cT) ON ACCOUNT OF APPROPRIATION NO. FOR G c r ba V l
(OFFICE, BOARD, DEPARTIRNT OR 1k [ON)
SPEEDOMETER AUIO EAG E
DATE FROM TO READING t NATURE OF BUSINESS MILES (Q
?b FOINT POINT START FINISH TRAVELED PER MILE
VMVTn '72
i
i
i
AUTO LICENSE NO. TOTALS
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1933, l hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing credits
end that ;q��
Date t t rj�he same has been paid.
Nov 05 2009 coo
it
ACCOUNTS PAYABLE VOUCHER
1' CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No,
360417 Davis, Jessica Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
10!30/09 Reimb. Mileage 10/1 10/30/09 28.05
Total 28.05
l hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20
Clerk- Treasurer
Voucher No. Warrant No.
360417 Davis, Jessica Allowed 20
In Sum of$
28.05
y ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #,rrITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 2 8.05 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
19 -Nov 2009
Signature
28.05 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund