176361 08/19/2009 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: $152.52
INDIANAPOLIS IN 46227
CHECK NUMBER: 176361
CHECK DATE: 8/19/2009
'DEPARTMENT ACCOUNT PO NU MBER INV NU MBER AMOUNT DESCRIPTION
1046 4343004 REIMB 152.52 TRAVEL PER DIEMS
PSESCRIDED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO 101 119867
MILEAGE CLAIM /J
ro j
(GOVERNMENTAL UmTr ON ACCOUNT OF APPROPRIATION NO. FOR
(pf10E, HOARD, DEPAATM27fT OA 1NHTCTIJTION)
SPEEDOMETER AUTO Mlt E AGE
D/AT�EE� FROM TO I T READING NATURE OF BUSINESS MILES
POINT POINT START FINISH TRAVELED PER MILE
1 r A bl t L
�Zt a t 7 s
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Y
AUTO LICENSE NO. �r 3
TOTALS
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map t
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 edit
end that no part of the same has been paid.
Date
9
J U '3 Boa
PRESCRIBED By STATE BOARD OF ACCOUNTS r.EWTRAL FOAM NO. 1 01 (1985)
MILEAGE CLAIM Amy y M,1 f n 0
TO
(GOVFANNENTAL UN1T7
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE. BOARD. DEPARTMEWT Oa INST[r 109)
SPEEDOMETER
2 DA -Fg FROM TO READING A UTO
ILES 4
NATURE OF BUSINESS
POINT POINT START FINISH TRAVELED PER MILE
1
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id Cl
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CA Ift
1 r t rep AUTO LICENSE NO, TOTALS 1' a
SPEEDOMETER HEADING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. t 1
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, f hereby certify that the foregoing account i0 just and correct, that the amount claimed is legally due, after allowing all just credits
end that no part of t e sa has been paid.
Date 7� I/CI��L�/ r
U s s
1 200
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
7131/09 Reimb. Mileage 7/1109 7131109 152.52
Total 152.52
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 -i0 1.6
20_
Clerk- Treasurer
Voucher No. Warrant No.
Muncy, Amy Allowed 20
In Sum of
152.52
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 152.52 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
13 -Aug 2009
V2
Signature
152.52 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund