208799 05/10/2012 CITY OF CARMEL, INDIANA VENDOR: 00353070 Page 1 of 1
ONE CIVIC SQUARE DAVID MCCOY
CARMEL, INDIANA 46032 C/o CHECK AMOUNT: $20.35
C/o is CHECK NUMBER: 208799
CHECK DATE: 5/10/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1202 4343002 20.35 EXTERNAL TRAINING TRA
N
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM I)A\f I
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING NATURE OF BUSINESS MILES Q,,S$ s
1 9 POINT POINT START FINISH TRAVELED PER MILE
G6 1'Z C f�M�(, bLte� �-rf1 (Sri�ER t t 14 LL. AM1MO Ce)lJlNj" Gis NlP 6
FGB iZ F(si s w. 4A -L.L. C RMF� Jp�iCG 5'r.A t(
tiPP�L_ Zs ?,0 1' 1 GA kMf-L_ ()oO STA NfOt3�. V (WC WJISTE WA rU' Z
A 2'k wAS lv.;kTJZ CA MGL p 5•rA i Z
MAY 1.ZU1Z
By
AUTO LICENSE NO. TOTALS '37 2�
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 after allowing all just credits
and that no part of the same has been paid
Date 1 4 2
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form.
That it is duly authenticated as required
by law
That it is based upon statutory authority,
f correct
That it is apparently S` incorrect
Disbursing Officer
On Account of Appropriation No. for
a� a
a M o n
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Allowed 19 0 a
in the sum of b tr
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(Board or Commission) as �i
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A.E. BOYCE CO., INC. MUNCIE, IN 01136
11 A+
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Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or 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.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
04/26/12 04.26.12 Mileage $20.35
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.
ALLOWED 20
David McCoy
IN SUM OF
$20.35
ON ACCOUNT OF APPROPRIATION FOR
IS Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1202 04.26.12 43- 430.02 $20.35
I 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
Monday, May 07, 2012
Director IS
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund