177310 09/15/2009 CITY OF CARMEL, INDIANA VENDOR: 361923 Page 1 of 1
ONE CIVIC SQUARE TIFARAH MCMULLIN
CHECK AMOUNT: $4.73
CARMEL, INDIANA 46032 ssi HOLIDAY DR
o FORTVILLE IN 46040 CHECK NUMBER: 177310
CHECK DATE: 9/15/2009
DEPARTI! %ENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343004 REIMB 4.73 TRAVEL PER DIEMS
PR"CRIHDD BY.SrATL BOARr1 OF ACCOUNTS
GFltF.RAL FORM NG. ICI 119867
4�JVC' MILEAGE CLA�TM
oovrAN>aeNrALtnurl ON ACCOUNT OF APPROPRIATION NO. FOR
LOMICF. BOARD, DUARTI� OR INSrr 10N)
FROM TO SPEEDOMETER AUTO lIII.EAGE
DATE READING
2 l POINT POINT STAA7 FINISH NATURE OF BUSINESS TRAVEL &b r
PER MILE
e,--
AUTO LICENSE NO- TOTALS d 73
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. llllll YYYJJJ I
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 aliowinq all just credi15
end that no part of the same has been paid.
Date
zo
Vj
AUG 2 6 2009
ACCOUNTS PAYABLE VOUCHER
r' 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.
McMullin, Tifarah Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
8126/09 Reimb. Mileage 8/4/09 4.73
Total 4.73
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.
McMullin, Tifarah Allowed 20
In Sum of
4.73
4r
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE N0. ACCT #MTLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 4.73 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
10 -Sep 2009
4"AXIA
Signature
4.73 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund