170419 04/01/2009 CITY OF CARMEL, INDIANA VENDOR: 358411 Page 1 of 1
0 ONE CIVIC SQUARE JENNIFER HAMMONS CHECK AMOUNT: $255.20
CARMEL, INDIANA 46032 634 NORTHVIEW AVENUE
INDIANAPOLIS IN 46220 CHECK NUMBER: 170419
CHECK DATE: 4/1/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1 1 046 4343004 REIMB 255.20 TRAVEL PER DIEMS
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purchase
Description p or F l
P.O. �001� 00
PRESCRIBED BY STATE BOARD Of ACCOUNTS G.L. ,f GENERAL FORM NO. 101 !19067
Budge MILEAGE CLAIM
(GOVERNMENTAL UNIT?
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ON ACCOUNT OF APPROPRIATION NO. FOR
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(OiiICE, BOARD. DEPARTT2lfr OR INSTITUTION)
FROM TO S PE E D M ER AUTO MILEAGE
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POINT
POINT START FINISH NATURE OF BUSINESS TRAVELED Q
PER MILE
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AUTO LICENSE NO. I '1 O! "I O"
TOTALS
READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. VL(,l_I 2G5,, 2-0
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 its
end that no part of the same has been paid.
Date 2
I/5 %9 2 127/( )q
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Wti 1 1 2009
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Purchase
Description p or F
PRESCRIBED BY STATE BOARD OF ACCOUNTS P.O. GENERAL FORM NO. 101 (1986)
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Purchaser D
(OF710E, BOARD, DEPARTMENT OR INSTmTrION)
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SPEEDOMETER
DATE FROM To READING NATURE OF BUSINESS MILS 1 E c
2� POINT POINT START FINISH TRAVELED PER MILE
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AUTO LICENSE NO. TOTALS O 1700V SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. U!
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 jus redits
and that no part of the same has been paid,
Dale 2— Z 7 9
7 M AR 1 1 2009
BY:
_t
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
10868 Gunnisan Ct Date Due
Fishers, IN 46038
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/27/09 Reimb. Mileage 1/5/09 2/27/09 WC 255.20
Total 255.20
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
i
Voucher No. Warrant No.
358411 Hammons, Jennifer Allowed 20
10868 Gunnisan Ct
Fishers, IN 46038
In Sum of
255.20
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT#/'rITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 255.20 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
25 -Mar 2009
Signature
255.20 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund