206004 01/31/2012 CITY OF CARMEL, INDIANA VENDOR: 363382 Page 1 of 1
ONE CIVIC SQUARE MEAGAN STORMS
CARMEL, INDIANA 46032 CHECK AMOUNT: $78.50
CHECK NUMBER: 206004
CHECK DATE: 1/31/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 78.50 TRAVEL FEES EXPENSE
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JAS 1 12012 1 &-Ii��
PRLSCRIBED BY STATE BOARD Or ACCOUNTS ELM IIK( it �T MILEAGE CLAIM GENERAL FORM 11G. 101 (1986)
TO
(OOVEANNENTAL UNIT
ON ACCOUNT OF APPROPRIATION NO. FOR
(OHICE, BOARD. DEPARTMENT OR INST=109)
E: FROM SPEEDOMETER AUTO
TO
2 DATE I READING NAT
NATURE OF BUSINE56 MILES a 1
POINT POINT START FINISH TRAVELED PERK
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pt� to c2 aI -7 r 1 5 L(
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AUTO LICENSE NO- TOTALS I I h
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. 1 l/
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing account is jus nd correct, that the amount claimed is legally due, a r aliowing all just credits
and that no part of the same has been paid.
Date
0q 13 cr
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.
363382 Storms, Meagan Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
12/30/11 Reimb Mileage 12/1 12/30/11 78.50
Total 78.50
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.
363382 Storms, Meagan Allowed 20
In Sum of
78.50
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. 4,CCT #1TITLE AMOUNT Board Members
Dept
1081 -7 Reimb 4343000 78.50 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
26 -Jan 2012
Q o bjvfi J
Signature
78.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund