170435 04/01/2009 CITY OF CARMEL, INDIANA VENDOR: 361054 Page 1 of 1
ONE CIVIC SQUARE CHARLES A IMAN
11018 TAM C'SHANTER DR CHECK AMOUNT: $61.60
�.�.o CARMEL, INDIANA 46032
CARMEL IN 46032 CHECK NUMBER: 170435
CHECK DATE: 4/112009
D EPARTMENT ACC OUNT P NUMB INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343004 REIMB 61.60 TRAVEL PER DIEMS
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (19%)
MILEAGE CLAIM
purchase TO
9
P(
P A Descr iption p
(GOVIRNMENTAI, P pU ON ACCOUNT OF APPROPRIATION NO FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
Budget
m ry SPEEDOMETER
DATE FROM er O to READING NATURE OF BUSINESS MILES MI_ x
Pur 19 POINT Approv START FINISH TRAVELED
PER MILE
InA i
G
G
V Y o I
r
2 ILI
h
r
AUTO LICENSE NO. TOTALS
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 a r allowing• all just credits,
end that no part a same has been paid.
MAR I. 1 200.9
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.
361054 Iman, Charles Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/3/09 Reimb. Mileage 2/2/09 2/27/09 CW 61.60
Total 61.60
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.
[man, Charles Allowed 20
361054
In Sum of
61.60
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 61.60 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
25 -Mar 2009
Z Lo�
Signature
61.60 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund