178043 10/14/2009 f CITY OF CARMEL, INDIANA VENDOR: 359600 Page 1 of 1
ONE CIVIC SQUARE HELEN BALLINGER
CARMEL INDIANA 46032 12913 CURRIER STREET CHECK AMOUNT: $28.93
CARMEL IN 46032 CHECK NUMBER: 178043
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CHECK DATE: 10/14/2009
DEPA RTMENT ACC PO NUMBER INVOICE NUMBER A AMOUNT DESCRIPTION
1125 4343004 REIMB 28.93 TRAVEL PER DIEMS
PRESCRIBED BY 111 BOARD OP AC[OUNIS MILEAGE CLAIM GENERAL FORM 110. G. tei IlsBS]
TO
(GOVERN 'L.UNl.
ff ON ACCOUNT OF RPPR P ATION NO FOR
T OT,ICE, Ia A D. DEPAATVMn OR INSTr[ O.
FROM l TO SP EED0
AUTO MILEAGE
DATE READING MILES Q C�`
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MILE t
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W Qj ]O ii n it M- (o
L 1uC �r1/N 0 vs /G/ fI t f mss, v
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AUTO LICENSE NQ, TOTALS
SPEEDOMETER HEADING columns are to be used only when distance between point< cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1353, 1 hereby certify that the foregoing account.is just and correct, that the amount claimed is le 1 e t r 1'I w' g ah credits
end that no part of the same has been paid.
Date
v
3 2009
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
359600 Ballinger, Helen Terms
12913 Currier Street
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
9123/09 Reimb Mileage 817 9122109 28.93
Total 28.93
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20_
Clerk- Treasurer
Voucher No. Warrant No.
359600 Ballinger, Helen Allowed 20
12913 Currier Street
Carmel, IN 46032
In Sum of$
28.93
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT #MTLE AMOUNT Board Members
Dept
1125 Reimb 4343004 28.93 1 hereby certify that the attached invoice(s), or
bili(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 -Oct 2009
Signature
28.93 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund