174901 07/22/2009 CITY OF CARMEL, INDIANA VENDOR: 358411 Page 1 of 1
ONE CIVIC SQUARE JENNIFER HAMMONS CHECK AMOUNT: $228.80
1, CARMEL, INDIANA 46032 634 NORTHVIEW AVENUE
INDIANAPOLIS IN 46220
CHECK NUMBER: 174901
CHECK DATE: 7/22/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343004 228.80 TRAVEL PER DIEMS
j
PRESCRIBED BY STATE BOARD OF ACCOUNTS (.I I JUL 1) L O 7 ?o0 n 1 GENERAL FORM NG. 1Q1 (19Bb�
e IVIJU jj MILEAGE CLAIM e K Grnw �S
TO
(GOVERNMENTAL UNTn
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTIQ7R OR 1NST(TVTION)
SPEEDOMETER
DATE FROM TO I READING AUTO MILES 20 POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MILE
'l l S-
4 t In
G
22
'1
9 .28
S•
•5
e
•1
I
26
LAD 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 legal due, after liow' 11 just credits
and that no part of the same has been paid.
Date
1
C
x
LL JNe4
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.
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
6/26/09 Reimb. Mileage 4/13/09 5/22/09 228.80
Total 228.80
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
.r
228.80
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 228.80 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
16 -Jul 2009
Signature
228.80 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund