179904 11/24/2009 CITY OF CARMEL, INDIANA VENDOR: 363392 Page 1 of 1
ONE CIVIC SQUARE JAMES WHITELEY
CHECK AMOUNT: $14.63
CARMEL, INDIANA 46032
o CHECK NUMBER: 179904
CHECK DATE: 11/24/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343004 REIMB 14.63 TRAVEL PER DIEMS
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENFAAL FORM 140. 101 (1986)
MILEAGE CLAoIM O��
(GOVERNMENTAL UNIT) Y
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF.ICE, BOARD, DEPART ZHT OA INSTRUTION)
DA•Z FROM TO SPEEDOMETER AUTO
READING
NATURE OF BUSINE56
POINT POINT START FINISH TRA M ILES MI
PER MI
4 Z
r I
P 2
r Z
Io
t O 7 -7 v+¢ w i
to J; P I E
D
AUTO LICENSE NO. O 6.4 326 4 1 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 155, 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
end that no part the same has been paid.
Date II 3�
19 10
NOV 0 5 2009 l
BY: t4l
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.
363392 Whiteley, James Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
10/30/09 Reimb. Mileage 10/5- 10/30/09 14.63
Total 14.63
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.
363392 Whiteley, James Allowed 20
In Sum of
14.63
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 14.63 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
19 -Nov 2009
Signature
14.63 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund