208305 04/25/2012 CITY OF CARMEL, INDIANA VENDOR: 365463 Page 1 of 1
ONE CIVIC SQUARE MATTHEW GREGORY
CARMEL, INDIANA 46032 C/O ESE CHECK AMOUNT: $105.30
s CHECK NUMBER: 208305
CHECK DATE: 4/25/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 105.30 TRAVEL FEES EXPENSE
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PRESCRIBED BY STATE BOARD Or ACCOUNTS MILEAGE CLAIM GENERAL FORM Nc. 101 (mb)
V r U Y
TO
(GOVERNMENTAL UNl'rl
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFiiCE, BOARD, DEPARTMr](r OR INSTRI noN)
SPEEDOMETER
DATE FROM TO I READING NATURE OF BUSINESS MIL O a S� S
2a POINT POINT START FINISH TRAVELED PER MILE
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AUTO LICENSE NO. TOTALS 1 f 1 5 3 0
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 at' ving all just credits
and that o pant o the s has been paid.
Date r
3q,3 O�
OIL vo-
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.
365463 Gregory, Matthew Terms
Invoice ;;mber oice Description
Date (or note attached invoice(s) or bill(s)) PO Amount
4/16/12 eimb Mileage 2/29 4/13/12 105.30
Total 105.30
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.
365463 Gregory, Matthew Allowed 20
In Sum of
105.30
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -7 Reimb 4343000 105.30 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
19 -Apr 2012
plvkd�m
Signature
I s 105.30 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund