180200 12/08/2009 CITY OF CARMEL, INDIANA VENDOR: 356305 Page 1 of 1
ONE CIVIC SQUARE DARRELL D NORRIS
CARMEL, INDIANA 46032 101 2ND AVE SW, #2C CHECK AMOUNT: $145.85
on CARMEL IN 46032 CHECK NUMBER: 180200
CHECK DATE: 12/8/2009
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DEPARTMENT ACCOUNT PO NUMB INVOICE NUMBER AMOUNT DESCRIPTION
1160 4343004 135.85 TRAVEL PER DIEMS
1160 4355100 10.00 PROMOTIONAL FUNDS
i
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE'ICLAIM
I TO (GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INST UTION)
SPEEDOMETER AUTO MILEAGE
DATE FROM TO READING
NATURE OF BUSINESS MILES
POINT POINT STAR'S FINISH TRAVELED PER MILE
�/�lm6L ��J,6 Ta fDri�l'd/<� .,��J �V' o ci G✓/yi. q0
L`'L !J Lc�✓C/ /GG�.. .[J�l/ S?O
ov r.J Z .,Z7W,, c�i i N' i t� 4Cv�� C7' �s d
45 �'��✓��c/iJ� G �U r)�$� G of ✓tJl� i it l/ e L�
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AUTO LICENSE NO. TOTALS 0 S L
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 legall due, after allowing 11 'ust credits
and that no part f the s me has been paid.
Date
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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
-1 by law
That it is based upon statutory authority.
That it is apparently I correct
t incorrect
Disbursing Officer
On Account of Appropriation No. for
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A.E. BOYCE CO., INC. MUNCIE, Qi 01136 n M
r Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
I
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
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whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
a ci C O NiJ .'j i✓�✓ui c� .1.ud �r�x,,p
Total Cod
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.
ALLOWED 20
IN SUM OF
1 I
44 44-0
ON ACCOUNT OF APPROPRIATION FOR
116 0
Yfj, 35/
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
s3ia� /D; 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
2007
Slgnatare
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund