172361 05/13/2009 CITY OF CARMEL, INDIANA VENDOR: 360464 Page 1 of 1
ONE CIVIC SQUARE LINDSAY HOLAJTER
CARMEL, INDIANA 46032 6628 BEAR CREEK DRIVE APT 1424 CHECK AMOUNT: $126.72
INDIANAPOLIS IN 46254
CHECK NUMBER: 172361
CHECK DATE: 511312009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4343004 126.72 TRAVEL PER DIEMS
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
0_nyELJt-L MILEAGE CLAIM l�LA J Z o g IN 11��I
(GOVERNMENTAL UNIT) A APR 2 7 2009
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION) BY:
SPEEDOMETER
DAT FROM TO I READING AUTO MIL AGE
V 09 NATURE OF BUSINESS MILES
POINT POINT START FINISH TRAVELED PER MILE
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AUTO LICENSE, NO. OTALS
'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 legall e, after aliowing all just credits
and that no part of the same has been paid. i
Date 9
r 4 l 4 7 0 5
I
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.
360464 Holajter, Lindsay Terms
6628 Bear Creek Dr., Apt 1424 Date Due
Indianapolis, IN 46254
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
4/27/09 Reimb. Mileage 2/2/09 4/22/09 126.72
Total 126.72
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.
360464 Holajter, Lindsay Allowed 20
In Sum of
.L
126.72
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 Reimb. 4343004 126.72 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
126.72 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund