173007 05/27/2009 CITY OF CARMEL, INDIANA VENDOR: 361801 Page 1 of 1
b ONE CIVIC SQUARE ALYSSA REYNOLDS
CARMEL, INDIANA 46032 11410 BURKWOOD DRIVE CHECK AMOUNT: $25.85
4 CARMEL IN 46033
CHECK NUMBER: 173007
CHECK DATE: 5/27/2009
DEPARTMENT AC COUNT PO N UMBER INVOIC NUMB AM OUNT DESCRIP
1046 4343004 2731 25.85 TRAVEL PER DIEMS
71
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
TO
(GOVERNMENTAL uxrt7 ON ACCOUNT OF APPROPRIATION NO. FOR ��►'�l S v"�' Y I�
(OFFICE, BOARD, DEPARTMENT OR 1NST1mT oR)
DATE FROM TO READING T +R AUTO MILEAGE
,,rte NATURE OF BUSINESS MILES Q 5540 0
ti 7 POINT POINT START FINIS
POINT 1. PER MILE
1 is E oln 0 V) 3
Z V) S _e CMOs 3 D
2 L I ((gg
tm a
t F DO p
S
I 'f f"J I S V
VyTi I T
f
fbe
W 22
Z JN6 0LlD /1
z S
f�b 0V1 O 1 2,0
e"Y7 2-
MDR S
W MAY
AUTO LICENSE NO. TOTALS
SPEEDOMETER READING columns are to be used .when distance between- points cannot be determined by fixed mileage or official highway map.
Pursuant toahe provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed is Iegally due, after allowing all just credits,
end that no part of the same has been paid.
Date
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
4130109 Reimb. Mileage 411109 4130109 25.85
Total 25.85
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 Reynolds, Alyssa Allowed 20
In Sum of
25.85
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 25.85 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
21 -May 2009
Signature
25.85 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund