175038 07/22/2009 CITY OF CARMEL, INDIANA VENDOR: 363113 Page 1 of 1
ONE CIVIC SQUARE AMY MUNCY
CARMEL, INDIANA 46032 2456 FOX HARBOUR S DRIVE CHECK AMOUNT: $129.07
INDIANAPOLIS IN 46227 CHECK NUMBER: 175036
«O 4
CHECK DATE: 7122/2009
DEPARTME ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343004 129.07 TRAVEL PER DIEMS
PRESCRIBED BY sTATE BOARD OF ACCOUNTS GENERAL FORM 110. KI (IV5)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRFATIDN NO. FOR
tOPME, BOARD. DEPARTMENT CA INBrrr MONI
SPEEDOMETER
DATE FROM TO I READING AUTO tdILEAGE C
NATURE OF BUSINESS MILES POINT POINT START FINISH TRAVELED
PER MILE
J3<7 iZyl h'
4 0
n P7 t
v C i
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 due, after allowing all just credits
end that no art of the same has been paid.
Date
roulX9
E:� e .4 f, V
JUL 0 7 1009
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERA-LFORM NO. 101 (1986]
MILEAGE CLAIM
TO
GqVERXMENTAL UUM ON ACCOUNT OF APPROPRIATION NO- FOR
(OHICE, BOARu, DEP&RTLM1fr OR )NST(TUTION)
SPEEDOMETER AUTO MILEAGE
DATE FROM TO READING NATURE OF BUSINESS MILES �57 C
POINT POINT START FINISH TAAV£L£D PER MILE
0
r oq
a u r 0 C "yb n bS-
2 y e- a r) tC x o
o� Mb tC w I✓lp ovt 51
�(Ah0- ak t) a le U Y\ ob U, k1 11„rV?
n2 ti f t
lavia 140 Hall un f L41i rY�t' 6CtaC tt O i
tAUV15vt fc�r -cr 6�u bh YL tJf i
U?D I- U b rtti, I F r
r q 11 F t 5 5 4- 0' T 0 n r 6 A r V) o
R lys' f e
rte, 1, 1 17
z g a
,I t to kv r v rA h LU p L T t Q
vnTy K
r. MA A rr f
LVO
AUTO LICENSE NO. TOTALS I I OIL tjj9—
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 1453, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after aliowing all just credits
and that no pa o t e same has been paid.
Date 1 14T I kw
r
Anlq ff(W169
PRESCRIBED By STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1966)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNln
ON ACCOUNT OF APPROPRIATION NO. FOR
(0F,10E, BOARD, DEPART60DrT ON INSTrr=IONI
SPEEDOMETER AUTO MILEAGE
DATE FROM TO I READING NATURE OF BUSINESS MILES r
�o- POINT POINT START FINISH TRAVELED
PER MILE
C
r 7 e a
n C A 141 d
r,1
%t .G 1
1U 3- I tA 4110
7v
tr P 1✓
f LC o ii o Y1 l! L I V�r-0
r7 tf.Y Q d/l a n o rt t
c .,•,4 rz
01 Z 5 11 a -1
J r _LAz�cl iW f4 11 I'd 061
i DI3 i^ tom/
gz2j, vt n -Vl W V, -e
W i
a A WVP 01r41
i'
n JAe-K.— FEE 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 due, after allowing all just cxedits
and that no part of the same has been paid,
Date
JU
f._.1 L 0 7
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.
Muncy, Amy Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
6/29109 Reimb. Mileage 612109 6129109 129.07
Total 129.07
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.
Muncy, Amy Allowed 20
In Sum of$
129.07
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #frITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 129.07 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
16 -Jul 2009
Signature
129.07 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund