169873 03/18/2009 CITY OF CARMEL, INDIANA VENDOR: 360417 Page 1 of 1
ONE CIVIC SQUARE JESSICA DAVIS
CARMEL, INDIANA 46032 CHECK AMOUNT: $57.68
CHECK NUMBER: 169873
CHECK DATE: 3/18/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2046 4343004 57.68 TRAVEL PER DIEMS
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PRESCRIBED 9Y STATE BOARD OF ACCOUNTS
GENERAL FORM NO. 101 (1486)
MILEAGE CLAIM
TO
l._..Ar�.MEL t-A�. lI4Qtis ar�D�EJ�no�
(GOVERNMMrNTAL UNITI
�XTENDL� �G4�. Si1.162K�lMEt�� ON ACCOUNT OF APPROPRIATION NO. FOR
(OF, BOARD, DEPARr.CEKT OA IN ION)
FROM TO T
LL5P£EDOMETER AUTO AGE
DATE READING
POINT POINT START FINISii NATURE OF BUSINE56 MMES TRAVELED PER MILE
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Y
I
AUTO LICENSE NO. TOTALS
SPEEDOMETER READING columns are to be used only when distance between points cann gv fixed mi age or official highway map.
phase. I
Pursuant to the Provisions and penalties of Chapter 155, Acts 1953, I h?i Qe that t account is MtoA correct the amount claimed is legally due after aliowing all lust credits
and that no part of the same has been paid. 00
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Date Q•0' -100 6k{
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uns l7escr pate --I
Purchaser pa e-6 F VRD
APPrO�� 7 2009
PAt5CRt9ED BY STATL 6pARU OF ACCOUNTS
GrNFRkL FORM NO- 101 119067
L MI LEAGE CLAIM
E L I&w&j t P611D "-Anc!kA TO
1GOVLARMENTAL UNn7
So r ON ACCOUNT OF APPROPRIATION ND, FOR VVV/NNN y
tOF�CP _E'S� A�AT}.�7fT Op IN ON}
FROM TO SPEEDOMETER AUTO E
DATE READING �L
POINT' POINT' START FINISH I�
NATURE OF BUSINESS MILES J
TRAVELED PER M1LE
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j)
FP
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AUTO LICENSE NO- TOTALS
SPEEDOMETER READING columns are to be used only when distance between points cannot be de =_ermined by fixed mileage or official highway map.
Pursuanl to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregonig account is just and correct, that the amount claimed is legally ue, after allowing credits
end that no part of the same has been paid.
Date purahasO 1
DescstP� p or F J
P.O.
Bud
g FEB 2 7 2009
Li Derma pate-
purch Date
APPrpve►
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.
Terms
360417 Davis, Jessica
Invoice Invoice Description
Date Number
or note attached invoice(s) or bill(s)) Amount
2!27109 Reimb. Mileage 1211108 1130109
57.68
Total 57.68
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.
360417 Davis, Jessica Allowed 20
In Sum of
57.68
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE N0. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 57.68 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
12 -Mar 2009
'NYOL ry) L-
Signature
57.68 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund