177686 09/29/2009 CITY OF CARMEL, INDIANA VENDOR: 358411 Page 1 of 1
ONE CIVIC SQUARE JENNIFER HAMMONS CHECK AMOUNT: $150.70
o CARMEL, INDIANA 46032 634 NORTHVIEW AVENUE
INDIANAPOLIS IN 46220 CHECK NUMBER: 177686
CHECK DATE: 9/29/2009
DEPARTM ACCOUNT PO NUMB IN VOICE NUMBER AMOU DE SCRIPTIO N
1046 4343004 REIMS V 150.70 TRAVEL PER DIEMS
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM No. 101 (1986)
MILEAGE CLAIM e n n a'� lAc`MYY��'Y�
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OiilCE, BOARD. DEPAATl.D7fT OA 1NSTCFULION)
TO SPEEDOMETER AUTO AGE
DATE FROM I READING NATURE OF BUSINESS MILES Qi c
2� POINT POINT START FINISH TRAVELED PER MILE
O c C
U
1.0
C- t
Z
w I C:t O 1O 10
41 L
W C
5 W I
Zl0 t0
ms 2
AUTO LICENSE NO. TOTALS �f
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 "ust credits
and that no part of the same has been paid. \A
Date cy
00 1 V
SEP
U
�3
1 2009
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, rated per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
358411 Hammons, Jennifer Terms
634 Northview Ave Date Due
Indianapolis, IN 46220
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
8/31/09 Reimb. Mileage 6/30 8/31/09 150.70
Total 150.70
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.
358411 Hammons, Jennifer Allowed 20
634 Northview Ave
Indianapolis, IN 46220
In Sum of
1ti.. 150.70
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #[TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 150.70 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
24 -Sep 2009
Signature
150.70 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund