177707 09/29/2009 a F CITY OF CARMEL, INDIANA VENDOR: 361054 Page 1 of 1
ONE CIVIC SQUARE CHARLES A IMAN
q 0 CHECK AMOUNT: $38.50
CARMEL, INDIANA 46032 11018 TAM O'SHANTER DR
N CARMEL IN 46032 CHECK NUMBER: 177707
CHECK DATE: 9/29/2009
DEPARTME ACCOUNT PO NUMBER IN VOICE NUMB AMO DESCRIPTI
1046 4343004 REIMB 38.50 TRAVEL PER DIEMS
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILE.AGE CLAIM A
(GOVERNMENTAL vxr17 ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OF INSTITUTION)
FROM TO SPEEDOMETER AUTO
DATE READING MILES
19 POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
ER MILE
i
7
q410
AUTO. LICENSE NO. TOTALS D i^
SPEEDOMETER READING columns are to be used only when distance between points 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,, allowing all just credits
Znd that no part of the same has been paid.
Dane
�doo-O y
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.
361054 Iman, Charles Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
9/9/09 Reimb. Mileage 8/12 9/9/09 38.50
Total 38.50
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
i
Voucher No. Warrant No.
Iman, Charles Allowed 20
361054
In Sum of
38.50
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 38.50 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
24 -Sep 2009
Signature
38.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund