174914 07/22/2009 CITY OF CARMEL, INDIANA VENDOR: 360926 Page 1 of 1
ONE CIVIC SQUARE SHAVONNE HOLTON
CARMEL, INDIANA 46032 3707 N MERIDIAN ST APT 38 CHECK AMOUNT: $87.70
INDIANAPOLIS IN 46208
CHECK NUMBER: 174914
CHECK DATE: 7/22/2009
D EPARTMENT ACCOU PO NUMBER INVOICE NUMBER AMOU DESCRIPTION
1046 4343004 62.70 TRAVEL PER DIEMS
1046 4359000 25.00 SPECIAL PROJECTS
r
Extended School Enrichment JUN 2 2 2009
Employee Referral Program 1046:4359000
By: a
ESE Employee: Start Date of Referral: Bonus mount:
14&I n S
Name of Referral: ESE School Site:
100 :54DC) Kjocd broa L
33a 9
ES oyee Signature D to
SE ision Manager Signature Date
PRESCRIBED BY STATE BOARD Of ACCOUNTS GENERAL FORM 110. 101 (1986)
MILEAGE CLAIM /n n �p L 1_-� C)
To V
(GOVERNMENTAL UNM ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD. DEPARTWNT OR INSTMMON)
SPEEDOMETER AUTO
g FROM TO READING NATURE OF BUSINESB MILES
POINT POINT START FINISH TRAVELED PER MILE
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n T e y
7
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C G. t Yl t0 5.
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AUTO LICENSE NO. TOTALS
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 legally due, after allowing all just credits
end that no art of the same has been paid.
Dat
1
9
UL
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.
360926 Holton, Shavonne Terms
8001 Canary Ln Apt A Date Due
Indianapolis, IN 46260
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
6/15/09 Referral Referral Program/Ashley Livingston 25.00
6/25/09 Reimb. Mileage 5/1/09 6/25/09 62.70
Total 87.70
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
360926 Holton, Shavonne Allowed 20
8001 Canary Ln Apt A
Indianapolis, IN 46260
In Sum of
87.70
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Referral 4359000 25.00 1 hereby certify that the attached invoice(s), or
1046 Reimb. 4343004 62.70 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
16 -Jul 2009
Signature
87.70 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund