176201 08/19/2009 CITY OF CARMEL, INDIANA VENDOR: 360282 Page 1 of 1
ONE CIVIC SQUARE ALICIA DECKARD
CARMEL, INDIANA 46032 CHECK AMOUNT: $275.55
•�0 8147 W 1050 S
FORNILLE IN 46040 CHECK NUMBER: 176201
CHECK DATE: 811912009
DE PARTMENT ACCOUNT PO NUMBER I NVOICE NUMBER A MOUN T DESCRI
1046 4343004 REIMB 275.55 TRAVEL PER DIEMS
M1 t
4
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 1 +0 101 [1986)
MILEAGE CLAIM
ro uL �JC.e.. GL
(GOVE WMENTAIL UN117
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF BOARD. DEPAArATWt OR INSTMJTION)
DAT FROM TO S RE�AD NG TAR AUTO EAGE
z� POINT POINT START FINISK NATURE OF BUSINESS TRA ELED
PER E
?i :2:
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y t r 4
q'11 7 t 1 I i
7
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r
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rr t I L4
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(r 41 Fr
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AUTO LICENSE NO. TALS ?S
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage ox 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 i gal due, after ro, ing all just cre
and that no p rt of th same has been paid.
Date 7
JUL
9, 2009
s�
PUSCRIBED BY STATE BOARD OF AOCOUNTS GENFARL FORD VI
MILEAGE CLAIM
To
IGOVERNNENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO- FOR
(OFFICE, BOARD, MUMMY OB 1WsrrrUTIQN)
FROM TO T SPEEDOMETER AUTO
DATE, READING NATURE OF BUSINESS MILES
Zo POINT POINT START FINTSN TRAtItsLED PEF
:Yjv I
/r tf !r
L( L C
If rJ Z20
rt Cr a2 jp 1I
tr If zi 1
t /t 5, A 4 1 lr
c
i
AUTO LICENSE NO. TOTALS
SPEEDOMETER HEADING 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 leg ly due, a aliowing al! ju redils
end that no pe of t same has been paid.
Date 7 z o
l000ll
J U L 2 9 TV,
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.
360282 Deckard, Alicia Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
7110109 Reimb. Mileage 3123109 711109 275.55
Total 275.55
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
Voucher No. Warrant No.
360262 Deckard, Alicia Allowed 20
In Sum of
275.55
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
Pa# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 275.55 1 hereby certify that the attached invoice(s), or
bitl(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
13 -Aug 2009
Signature
275.55 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund