171882 04/29/2009 CITY OF CARMEL, INDIANA VENDOR: 361054 Page 1 of 1
ONE CIVIC SQUARE CHARLES A IMAN CHECK AMOUNT: $80.85
CARMEL, INDIANA 46032 11018 TAM O'SHANTER DR
CARMEL IN 46032 CHECK NUMBER: 171882
CHECK DATE: 4/29/2009
DEPARTMENT ACCOUNT PO NU MBER I NVOIC E N UMBER A DESCRIPTION
1046 4343004 80.85 TRAVEL PER DIEMS
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM No. 101 (1986)
i MILEAGE CLAIM
(GOVERNMENTAI UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
DATE FROM TO SPEEDOMETER
T +R AUTO MI LEA E
NATURE OF BUSINESS MILES C c
19 POINT POINT r,RT FINISH TRAVELED PER MILE
g
5
6
�2 U
lu
4 h a
(`1
10
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 le
ly
d L flowing' all just credits
2nd that no part of th same has been paid. F
Date
APR t
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
3/31/09 Reimb. Mileage 3/2/09 3/31/09 80.85
Total 80.85
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
w Rf1,R5
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 80.85 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
22 -Apr 2009
Signature
80.85 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund