172243 05/13/2009 CITY OF CARMEL, INDIANA VENDOR: 360144 Page 1 of 1
ONE CIVIC SQUARE CYNTHIA CANADA CHECK AMOUNT: $134.58
CARMEL, INDIANA 46032 11508 LUCKY DAN DRIVE
NOBLESVILLE IN 46060 CHECK NUMBER: 172243
CHECK DATE: 5/13/2009
DEPARTMENT ACCOUNT P O NUMBER INVOICE NUM AMOUNT DESCRIPTION
1046 4343004 134.58 TRAVEL PER DIEMS
lb-
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NC. 101 (1986)
MILEAGE CLAIM
TO C -O n a-J
(GOVERNMENTAL UNI17
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF110E, BOARD, DEPAATMFTfr OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
i
DATE READING
z° POINT POINT START FINISH NATURE OF BUSINESS MILES a
TRAVELED PER MILE
Yh 3
1
Pl'l
V I r1
r Sr L 4
c r C 3
r t 1 5 -S
v
C
l7n Q
C--
iY1Dr S 13. Ll
Hns e 02,A—LA
i
c 3
L4 rn�' C r 3.
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 legally due, after atiowing all just credits
end that no part o the same has been paid.
Date
APR 2 9 2009 y 5S O
BY:
PROSCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NC. ICI (1986)
MILEAGE CLAIM
ro
(GOVERNMENTAL UN171
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF, BOARD, DEPARTT47fT OR INSTITUTION)
DATE
SPEEDOMETER AUTO TIILEAGE
Z
FROM To READING NATURE OF BUSINESS MILES
Q S POINT POINT START FINISH TRAVELED pEp MILE
L
YY�
M S t o
a n
o e
in yn
a M
A
2 uQ,r i rrl
M
Z44 4-
AD Yl AD
re YY� fop i
r
NN —k 3
T
i
lti .J� I c
i r i Q_ T C' cc e—
ra -Tr- -c 5 2
AUTO LICENSE NO. TOTALS I r S 5 0 1
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 legally due, after aliowing all just credits
end that n part of t e same has been paid.
Date oC O p 1V
APR 2 9 2009
BY:
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
360144 Canada, Cyndi
11508 Lucky Dan Dr
Noblesville, IN 46060
Invoice Invoice Description PO Amount
Date Number (or note attached invoice(s) or bill(s))
134.58
4128/09 Reimb. Mileage 2/19/09 4/28/09
Total E$1
I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20
Clerk- Treasurer
Voucher No. Warrant No.
360144 Canada, Cyndi Allowed 20
11508 Lucky Dan Dr
Noblesville, IN 46060
In Sum of$
134.58
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. y,��f3D0� 134.58 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
7 -May 2009
Signature
134.58 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund