173443 06/10/2009 CITY OF CARMEL, INDIANA VENDOR: 00353070 Page 1 of 1
ONE CIVIC SQUARE DAVID MCCOY
CHECK AMOUNT: $29.70
CARMEL, INDIANA 46032 c/o
C/o is CHECK NUMBER: 173443
CHECK DATE: 6/10/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NU AMOUNT D ESCR IPT ION
1202 4343002 29.70 EXTERNAL TRAINING TRA
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PRESCRIBED BY STATE BOARD OF ACCOUNTS t i GENERAL FORM NO. 101 (1886)
MILEAGE CLAIM
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTMMON)
SPEEDOMETER AUTO MILEAGE
DATE FROM TO READING
NATURE OF BUSINESS MILES ,i S c
POINT POINT START FINISII
TRAVELED PER MILE
r p o L i i ?e;� r 1>-
13 0 `i W 1- C t C1= P&P
l S o ci L i r� P I t F_ -G t� CFr•�.� 1
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 155, Acts 1953, I Hereby certify that the foregoing account is just and correct, that the amount claimed is legally dire, after allowing all just credits
and that no part of the. same has been paid.
Date
Claim "No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form.
V y That it is duly authenticated as required
2 C1Z by law
That it is based upon statutory authority.
correct
That it is apparently
incorrect
Disbursing Officer
On Account of Appropriation No. for o cr w
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in the sum of m m
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(Board or Commission) m
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A.E. BOYCE Co., MC. MUNCIE, IN 02136 lQ 0 I
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P,jesc!ibed b4 State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
CITY OF CARMEL
An invoice or 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
David McCoy Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
osig i In Mileage $29. 10
Total
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 O 08 WARRANT NO.
ALLOWED 20
IN SUM OF
$29.70
ON ACCOUf�ToF f P�R 4BDN FOR
1202 Information Systems
Board Members
PO# or DEPT INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
ZuZ 430 $29.70 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
20
Si ature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund