170299 04/01/2009 a- F CITY OF CARMEL, INDIANA VENDOR: 359600 Page 1 of 1
ONE CIVIC SQUARE HELEN BALLINGER
CHECK AMOUNT: $29.87
CARMEL, INDIANA 46032 12913 CURRIER STREET
CARMEL IN 46032 CHECK NUMBER: 170299
CHECK DATE: 4/1/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMB AMOUNT DESCRIPTION
1125 4343004 1125 29.87 TRAVEL PER DIEMS
i
PRESCRIBED BY STATE BOARD OF ACCOUNTS.
GENERAL FORM NO. 101 (1986)
MILEAGE'CLAIM
TO
(GOVERNME AL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOA D, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING NATURE OF BUSINESS MILES SS a
4 0 POINT POINT START FINISH TRAVELED PER MILE
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it
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AUTO LICENSE NO.
IBY:
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 le all d .after a'owing all just credits
.and that no part of the same has been paid.
Date
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form.
That it is duly authenticated as required
by law
That it is based upon statutory authority.
That it is apparently correct
incorrect
Disbursing Officer
On Account of Appropriation No. for
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A A.E. ROYCE CO., INC. MUNCIE, IN 01136 a
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)) Amount
3111109 Reimb Mileage 1/22109 316109 29.87
Total 29.87
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
29.87
ON ACCOUNT OF APPROPRIATION FOR
101 -General Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 Reimb 4343004 29.87 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
25 -Mar 2009
Signature
29.87 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund