206313 02/14/2012 CITY OF CARMEL, INDIANA VENDOR: 366039 Page 1 of 1
ONE CIVIC SQUARE BECKY KAPSALIS
CARMEL, INDIANA 46032 CHECK AMOUNT: $7.77
CHECK NUMBER: 206313
CHECK DATE: 2/14/2012
DEPARTMENT ACCOUNT PO NUMBE INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 7.77 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING MILES 6 S. 5 x
NATURE OF BUSINESS
POINT POINT START FINISH TRAVELED PER MILE
AUTO LICENSE NO. TOTAL$ 1
SPEEDOMETER READING columns are to be used only when distance betwe points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I here certify that the foregoing account is just and correct, that the amount claimed is legally due, after ali wing all just edits
and that no part of the sa e has been paid.
Date
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
1 Vt
An invoice of bill to be properly itemized must show; kind of service, where performed dates service rendered by
P p y p
y
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Kapsalis, Becky Terms
�y
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s))
1/25/12 Reimb Mileage 1/24/12 PO Amount
7.77
r
I hereby certify that the I
with IC attached invoice(s), or bill s
5-11- 1 0-1.6
is (are) true and
correct and I have au Ot c r
20 m a11 oC al
I
a
a `ti
Voucher No. Warrant No.
Kapsalis, Becky Allowed
s
Y4�
MO VE
In Sum 0
f Y
7
7.77
Y
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
be(5
Board moo
e(s
PO# or e
a= INVOICE NO. CCT #/TITL AMOUNT tn�l° at tr
Dept that the attached
7.77 certify
d t
1081 -10 Reimb 4343000 I hereby true and correct t r
bills is (are)
itemized
ce the
P y d a
materials
which charge is or service
Were orde�e
received except
2
CJ
1�
Q/ 1Q
7.77
Cost distribution ledger classification if
claim paid motor vehicle highway fund