208030 04/10/2012 CITY OF CARMEL, INDIANA VENDOR: 364943 Page 1 of 1
ONE CIVIC SQUARE VICKI RUBIO
CHECK AMOUNT: $70.02
CARMEL, INDIANA 46032
CHECK NUMBER: 208030
CHECK DATE: 4110/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 70.02 TRAVEL FEES EXPENSE
GENERAL FORM NO. IOI (1986)
PRESCRIBED BY STATE BOARD OF ACCOUNTS
MILEAGE CLAIM
C,, C- V2 p V
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OMCE, BOARD, DEPARTMENT OR INSTn UTION)
FROM TO SPEEDOMETER AUTO AAGF
D T t4I1.
E Cd ,5
24 I READING NATURE OF BUSINESS MILES
POINT POINT START FINISH TRAVELED PER MILE
IVL(L C_
r t C�--
C. Lt) C!_
N AA
Ju
S
i
I
AUTO LICENSE NO. TOTALS 6
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 aliowin all just credits
end that no part of the same has been paid. N
Date c.I l l�
MAR 3 0 2012
BY
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.
364943 Rubio, Vicki Terms
Invoice ;Nu ice Description
Date ber (or note attached invoice(s) or bill(s)) PO Amount
3/29/12 mb Mileage 3/2 3/29/12 70.02
Total 70.02
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.
364943 Rubio, Vicki Allowed 20
In Sum of
70.02
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT WTITLE AMOUNT Board Members
Dept
1081 -3 Reimb 4343000 70.02 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
5 -Apr 2012
Signature
70.02 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund