206166 02/14/2012 CITY OF CARMEL, INDIANA VENDOR: 360144 Page 1 of 1
ONE CIVIC SQUARE CYNTHIA CANADA
0 CHECK AMOUNT: $61.93
CARMEL, INDIANA 46032 11508 LUCKY DAN DRIVE
NOBLESVILLE IN 46060 CHECK NUMBER: 206166
CHECK DATE: 2/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 61.93 TRAVEL FEES EXPENSE
PPPSCRISED BY STATE BOARD OF ACCOUNTS GENERAL FOAM 110. 101 (1986)
MILEAGE CLAIM Lj
ro (GOVERNMENTAL UNrn ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, HOARD, DEPARTMENT OR INSTITUI10N)
SPEEDOMETER AUTO
DATE
FROM TO READING NATURE OF BUSINESS MISS r
Zd POINT POINT START FINISH TRAVELED PER MILE
1 r
All nn�jp
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 legally due, after allowing all just credits
end tha no part Of the same has been paid.
Date'
Dat i���l V
JAN 4 2011
BY:
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 110. 101 11986)
MILEAGE CLAIM
TO A 0 C„\ 1 r C A C
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
C&FICE, BOARD, DEPARTMENT OR INS TTIniON)
SPEEDOMETER AUTO UILE j
DATE FROM TO I READING NATURE OF BUSINESS MILES
2a POINT POINT SrAA7 FINISH TAAVELfiD PER LE
S)
ci
i
O 't�
d V1 I
f'Y)+, Z)
r
I
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LA
n
a
-jr 7 9 1
lal —1 f, 0 Q L& T-yr\\2- 3
j (YN T I
ion nn C
a
s
-lam
AUTO LICENSE NO. TOTALS o a
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 legally due, after allowing all just credits
end that n� part of the same has been paid.
Date
Ir o
JAN
z 4 2012
I�
BY.
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.
360144 Canada, Cyndi Terms
11508 Lucky Dan Dr
Noblesville, IN 46060
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1/23/12 Reimb Mileage 10/19 12/20/11 61.93
Total 61.93
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
Voucher No. Warrant No.
360144 Canada, Cyndi Allowed 20
11508 Lucky Dan Dr
Noblesville, IN 46060
In Sum-of
61.93
I
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -5 Reimb 4343000 61.93 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
9 -Feb 2012
Signature
61.93 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund