168438 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: 360282 Page 1 of 1
ONE CIVIC SQUARE ALICIA DECKARD CHECK AMOUNT: $102.38
CARMEL, INDIANA 46032 8147 w 1050 S
FORTViLLE IN 46040 CHECK NUMBER: 168438
CHECK DATE: 214/2009
DEPARTMENT ACCOUNT PO NUMBER IN NUMB T AMOUNT DESCRIPTION
1046 4343000 REIMB 102.38 TRAVEL FEES EXPENSE:
�e
PRLSCB(BED BY STATE BOARD OF ACCOUNTS GF2[ERAL FORW NO. IN tt9R6)
MILEAGE o CLAIM l IM u 1� f
(GOVEPN,MENTAL UNIT}
ON ACCOUNT OF APPROPRIATION NO- FOR
(OF77CE, BOARD, DUARTb4NT OR INSTiTITTION)
Art
FROM TO SPE N AUTO
DAB JTF�(� REf4DI NG NATURE OF BUSINESS MILES 0 MILE
Za =t+ POINT POINT START FINISH TRAVELED
PER MILE
g o
c
177
71 1
7 „t. i "1
V 1
t
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 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed is legall due, after 7 ing all jus credits
and th t p rt of s
a am as been paid.
Date
JAN 1 5 2000
BY:
ACCOUNTS PAYABLE VOUCHER
C ITY p� CARMEL
where performed, dates service rendered, by
ized must show; kind of service, rice per unit, etc.
per hour, nmber of units, p
An invoice of bill to be properly be itemr of hours, rate p u
whom, rates per day,
purchase Order Na.
payee Terms
30 02$2 Decicard, Alicia
Amount
Description s or bill(s)) 102.38
Invoice Invoice (or note attached invoiceO
Date Number 12123108 Prairie Trace
12123!08 Reimb. Mileage 121110
Total 102.38
s or bills) is (are) true and correct and l have audited same in accordance
I hereby certify that the attached invoice(
with IC 5 11 -10 1.6
20, Clerk Treasurer
Voucher No. Warrant No.
360282 Deckard, Alicia Allowed 20
In Sum of
�J
102.38
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343000 102.38 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 i
received except
27 -Jan 2009
Signature
102.38 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund