176130 08/19/2009 CITY OF CARMEL, INDIANA VENDOR: 359600 Page 1 of 1
e' ONE CIVIC SQUARE HELEN BALLINGER CHECK AMOUNT: $33.66
CARMEL, INDIANA 46032 12913 CURRIER STREET
CARMEL IN 46032 CHECK NUMBER: 176130
CHECK DATE: 8/1912009
_DEPARTMENT F ACC Y PO NUMBER INVOICE NU AMO UNT DESCRIPTION
1125 4343004 REIMB 33.66 TRAVEL PER DIEMS
s
PRESCRIBED By STATE BOARD OF ACCOUNTS GENERAL FORM NO. ID) VW5)
MILEAGE CLAIM l%JL-
1 �r g �rk�
ERNMENTAL 11 Sin, c ✓l E C1 AC61 ON ACCOUNT OF APPROPRIATION NO, FOR
LOF7ICE, BOARD, DEPARTMENT OR INgT n UTION)
DATE FROM TO SPEEDOMETER —r -J- READING f AUTO 1dILEA
NATURE OF BUSINESS MILES Gn
POINT POINT START FINISH 1'RRVELED PER MILE
yLy
q 1i
E Ylt PrtN ;7J64
go
i-aC e 1, (Let
5
rr I r I.
4
A�7u!
r r I(
4
o f If
i it 1 91�c I
rl Mk W- t('A0..s[ 1 Hcif
i l e 6' I 8
A
W ;x
Y-7
U d
3[ nur9�ICENa xo. ftW -iQ, 14A'-L TOTALS
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. C3 f'
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 AllowmgAl just credits
end that no part of the same has been paid.
Date
I /a
7 IIE (P
AUG 5 200
...(...C............
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
F Carmel, IN 46032
Y
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
814109 Reimb Mileage 6/3/09 7131109 33.66
Total 33.66
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
33.66
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 Reimb 4343004 33.66 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
13 -Aug 2009
Signature
33.66 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund