175100 07/22/2009 CITY OF CARMEL INDIANA VENDOR: 361801 Page 1 of 1
ONE CIVIC SQUARE ALYSSA KARSAS
CARMEL, INDIANA 46032 15439 HARMON PLACE CHECK AMOUNT: $27.50
NOBLESVILLEIN 46060
eo CHECK NUMBER: 175100
CHECK DATE: 7/22/2009
DEPARTMENT ACCOUNT PO NUMBER INV OICE NUMBER AMOUNT DESCRIPTION
1046 4343004 REIMB 27.50 TRAVEL PER DIEMS
JUL 0 7 7.009
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1985)
MILEAGE CLAIM
(GOVERNMENTAL UNIT) P A SS N Re O d S
ON ACCOUNT OF AP NO. FOR
(OFFICE, BOARD. DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
za D n READING NATURE OF BUSINESS MILES Cw 6
POINT I POINT START FINISH TRAVELED II PER MILE
C
C c I
D I I ND i
.I va I CWF K C- i I 2tWY'7 1 (4,9
_�v I I"$ G D�1 T�i� al
0 11 1
L0 (0 4 E �i i nW c
WCF
yam-__ -tl
I
I I
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 15S, Acts 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after aliowing all just credits A It
r end that no part of the same has been paid. /Date 301
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.
361801 Reynolds, Alyssa Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
6/30/09 Reimb. Mileage 5/26/09 6/30/09 27.50
Total 27.50
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
Voucher No. Warrant No.
361801 Alyssa Allowed 20
In Sum of
27.50
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 27.50 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
27.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund