168526 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: 361054 Page 1 of 1
ONE CIVIC SQUARE CHARLES A IMAN
CHECK AMOUNT: $53.23
R CARMEL, INDIANA 46032 11018 TAM O'SHANTER DR
`o CARMEL IN 46032 CHECK NUMBER: 168526
CHECK DATE: 214/2009
DEPARTMENT ACCOUNT PO NUMBE INVOIC NUMBER AMOUNT DESCRIPTION
1046 4343000 53.23 TRAVEL FEES EXPENSE
X';
PRESCRIBED BY STATE BOARD OF ACCOUNTS i GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
.iL TO
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER
FROM TO I
DATE READING AUTO' MILEAGE
MILES 1 59
19 POD POINT START FINISH NATURE OF BUSINESS TRAVELED 5 c
n PER MILE
i r_
r
1
j� A
a�
r g
AUTO LICENSE NO. TOTALS
SPEEDOMETER READING columns are to be used only when distance between pcints 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 aad correct, that the amount claiined is legally due, ajfe lowing all just credits
znd that no part of e same has been paid.
Date 7 a
JAN 2009 V
'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)) Amount
1/9/09 Reimb. Mileage 12/01/08 12/18/08 College Wood 53.23
Total 53.23
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
I
Voucher No. Warrant No.
Iman, Charles Allowed 20
361054
In Sum of
53.23
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343000 53.23 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
27 -Jan 2009
0 ,j
I
Signature
53.23 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund