174963 07/22/2009 CITY OF CARMEL, INDIANA VENDOR: 357976 Page 1 of 1
D ONE CIVIC SQUARE BENJAMIN JOHNSON
CARMEL, INDIANA 46032 8416 MANSHIP DRIVE CHECK AMOUNT: $68.20
`4a'co FISHERS IN 46038 CHECK NUMBER: 174963
CHECK DATE: 7I2212D09
DEPA RTMENT A CCOUN T PO NUMBE INVOICE NU MBER AMOUNT DESCRIPTION
1046 4343004 68.20 TRAVEL PER DIEMS
PRESCRIBED_, (STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM O
a J U r I TO
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MI E GE
DA+�T�EtOS READING NATURE OF BUSINESS MILES
POINT POINT START FINISH TRAVELED PER MILE
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s rn \d gm
tvl
6—
10 0
3
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I G S
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M M
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AUTO LICENSE NO. TOTALS J UL 0 2 1009 �0
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 a owing all just credits
and that no part of the same has been paid.
Date
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form.
That it is duly authenticated as required
by law
That it is based upon statutory authority.
That it is apparently correct
incorrect
Disbursing Officer
On Account of Appropriation No. for
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in the sum of
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A.E. BOYCE CO., INC. MUNCIE, IN 01136
i
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 Johnson,Ben Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
6/11109 reimb. Mileage 3112109 6111109 68.20
Total 68.20
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
1 20
Clerk- Treasurer
i
Voucher No. Warrant No.
357976 Johnson, Ben Allowed 20
In Sum of
68.20
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb 4343004 68.20 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
16 -Jul 2009
Signature
68.20 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund