177591 09/29/2009 CITY OF CARMEL, INDIANA VENDOR: 360144 Page 1 of 1
ONE CIVIC SQUARE CYNTHIA CANADA
CARMEL, INDIANA 46032 11508 LUCKY DAN DRIVE CHECK AMOUNT: $103.29
NOBLESVILLE IN 46060 CHECK NUMBER: 177591
CHECK DATE: 9/29/2009
DEPAR ACCOUNT PO NUMBER INVOIC NUMBER AMOUN D
1046 43430U4 REIMB 103.29 TRAVEL PER DIEMS
SEP 1 5 1009
PRCSCRIBCD BY STATE BOARD OF ACCOUNTS i•�.W
GENERAL FORM NO. lei (1986)
MILEAGE CLAIM
(GOVERNMENTAL UNITI TO
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF, BOARD. DEPART EKT OR INSTTTUCION)
FROM TO SPEEDOMETER AUTO E
DATE READING i-
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
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AUTO LICENSE NO. TOTALS 7
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. D Iii L- 4
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 aliowing all just credits
end that o f t �r
gas been paid.
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Date y
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PRESCRIBED BY STATE BOARD OF ACCOUNTS S E 1 5 2009 GENERAL FORN NO. ILI (1986)
MILEAGE CLAIM
(OOVEANN ENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OHICE, BOARD, DE)AATWENT OR INSnTUTION)
FROM TO SPEEDOMETER AUTO MFE
DATE I READING
2� POINT POINT START FINISH NATURE OF BUSINES6 TRAVELED a
P ER MTLE
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AUTO LICENSE NO. TOTALS
SPEEDOMETER READING columns are to be used only when distance between points cannot be detr_rmined 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 aliowing all just credits
end that no part t has been paid.
Date
o
-I
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.
360144 Canada, Cyndi Terms
11508 Lucky Dan Dr
Noblesville, IN 46060
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Invoice Invoice Description
Date Number (or note attachbq invoice(s) or bill(s)) PO Amount
V
9/14/09 Reimb. Mileage 7/7 9/14/09
50.71
Total 50.71
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.
360144 Canada, Cyndi Allowed 20
11508 Lucky Dan Dr
Noblesville, IN 46060
In Sum of
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 1 I 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
24 -Sep 2009
Signature
55 5T Accounts Payable Coordinator
Cost distribution ledger classification if �_22A Title
claim paid motor vehicle highway fund at,