170080 03/18/2009 CITY OF CARMEL, INDIANA VENDOR: 361801 Page 1 of 1
ONE CIVIC SQUARE ALYSSA REYNOLDS
q O CHECK AMOUNT: $56.37
CARMEL, INDIANA 46032 11410 BURKWOOD DRIVE
CARMEL IN 46033 CHECK NUMBER: 170080
CHECK DATE: 3/18/2009
DEPARTMENT ACCOUN PO NUMBER INVOICE NUM AMOUNT DESCRIPTION
1046 4343004 56.37 TRAVEL PER DIEMS
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
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Purchase °n O0c�1 M CLAIM
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(oovERNMENTAi'vNrr) ON ACCOUNT OF APPROPRIATION NO. FOR
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1
(OFFICE, BOARD, DEPARTMENT OR INSTITU'''ION) g� hVW4
P ro SPEEDOMETER AUTO MILEAGE
FROM PP TO READING
DATE NATURE OF HUSIMs'SS MILES Q 55 D
a
1 POINT POINT START FINISH TRAVELED PER MILE
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2009. I
AUTO LICENSE 110, TOTALS
SPEEDOMETER READING columns are to be i °.sed 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 arld correct, that the amount claimed is legally due, after allowing all just credits
and that no �p']art O of the same has been paid.
Date 1 �I 7'
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORM NO. 101 (1966)
ILEAGE CLAIM
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(GOVERNMENTAL uxtT) P 117' ON ACCOUNT OF APPROPRIATION NO. FOR ass R y� o I dS
(OFFICE, BOARD, DEPARTMENT OR INSTMMOh� e dge 0! CL D�
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FROM SPEEDOMETER.
DATE Q�tCohag TO READING AUTO MILEAGE
0 Q9 POINT APPre INT START FINISH NATURE OF BUSINESS TRA TO SS I x
lV F D E p
PER MILE
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AUTO LICENSE NO. l i� T TOTALS
Y
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 allowing all just credits
end that no part of the same has been paid.
Dat C
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)) Amount
2127109 Reimb. Mileage 116109 2127109 56.37
Total: 56.37
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
Voucher No, Warrant No.
361801 Reynolds, Alyssa Allowed 20
In Sum of
56.37
6
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TlTLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 56.37_ 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
12 -Mar 2009
Signature
56.37 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund