170459 04/01/2009 a CITY OF CARMEL, INDIANA VENDOR: 357976 Page 1 of 1
ONE CIVIC SQUARE BENJAMIN JOHNSON
CARMEL, INDIANA 46032 8416 MANSHIP DRIVE CHECK AMOUNT: $58.85
FISHERS IN 46038
CHECK NUMBER: 170459
CHECK DATE: 4/1/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343004 REIMB 58.85 TRAVEL PER DIEMS
Lam"" P Off
P
r 00700,
PRESCRIBED BY STATE BOARD OF ACCOUNTS G. GENUAL FORM NO. 101 (1986)
�j eDescr DMA CLAIM
TO
(GOVERNMENTAL UNIT)
Ap ps ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTFI]IT OR INSTITUTION)
DATE FROM TO READING +ER AUTO MILE E MILES
--1- PONT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MILE
MON K PA AJL MI A4T2
61 5M-I-_ A K)
OrJ iA1 Oo v0 1
ro o !lk
9 /L JME 1 O
f �t
N L rJ AJ Co.• t vl f T7t�
N
F 95 WR Mon�rJ f
5-M 0 c.I r e-eN dAaJ G�L.�M
Ql1 ST JM Gt l t
o ate__ S Q) S IT t
o p
}vFJ zit nn v 1✓ e t
(t
emj iwe T f OF
OnI0i..7 G,Tf< CMLWI
/✓t o, �o� J G'T LT /L r
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, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally du after aliowing all just credits.-
end that no part of the same has been paid. /7
Date
MAR 1 1 zoos
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.
357976 Ben Johnson Terms
8416 Manship Dr Date Due
Fishers, IN 46038
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/11/09 reimb. Mileage 1/15/09 3/5/09
Total
I 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.
Ben Johnson Allowed 20
8416 Manship Dr
Fishers, IN 46038
In Sum of
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT WTITLE AMOUNT Board Members
Dept
1046 Reimb 4343004 5 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
5g Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
t