168034 01/21/2009 CITY OF CARMEL, INDIANA VENDOR: 360926 Page 1 of 1
ONE CIVIC SQUARE SHAVONNE HOLTON
0 CHECK AMOUNT: $29.84
CARMEL, INDIANA 46032 4001 CANARY LANE, APT A
')iANAPOUSw aszso CHECK NUMBER: 168034
CHECK DATE: 1/21/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343000 29.84 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NQ 101 119e6)
MILEAGE CLA�IM��QV \4 7
(GOVERNMENTAL UNITn
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER AUTO MILEJLGE
ZoD FROM TO READING NATURE OF BUSINESS MILS a t
POINT POINT START FINISH TRAVELED PEAS
1 r t'y
b „0
5
11
C 5
n rA
o n
AUTO LICENSE NO. TOTALS r1
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway ma L
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 claime 's 1 kly ue, ft r liowinq all just credits
end that no part of t e sam has been paid.
Date T
f
DEC 0 5 2008
ACCOUNTS PAYABLE VOUCHER
G,TY 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)) Amount
12/1/08 Reimb. Mileage 11/04/08 11/25/08 29
Total 29.84
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
f
Voucher No. Warrant No.
360926 Holton, Shavonne Allowed 20
8001 Canary Ln Apt A
Indianapolis, IN 46260
A I n Sum of
29.84
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
P *J# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343000 29.84 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
2009
Signature
29.84 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
1