209331 05/22/2012 CITY OF CARMEL, INDIANA VENDOR: 364943 Page 1 of 1
0 ONE CIVIC SQUARE VICKI RUBIO
CARMEL, INDIANA 46032 CHECK AMOUNT: $54.46
CHECK NUMBER: 209331
CHECK DATE: 5/22/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 54.46 TRAVEL FEES EXPENSE
1
CEIVED
=BY: GENF.RXL
PRESCRIBED 87 STATE BOARD Or ACCOUNTS FORM NC. 101 119861
MILEAGE CLA
ca� V
(GOVERNMENTAL UNm
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF77CE, BOARD. DEPARTMETrr OR INSITFVr6ON)
SPEEDOME +ER AUTO !�i 11
DATE FROM TO READING
NATURE OF BUSINESS MILES Z� _U_ POINT POINT START FINISH TRAVELED PER MILE
CJ_'J
C, s
CIA 7
Ct
LU
C
s
C_ c tv f i
AUTO LICENSE NO. TOTALS 1 Iv
3% 5_�
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 dua, after al' ing all just credits,-
and that no part of the same has been paid.
Dat
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 Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
5/1/12 Reimb Mileage 4/2 5/1/12 54.46
Total 54.46
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
54.46
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #[TITLE AMOUNT Board Members
Dept
1081 -3 Reimb 4343000 54.46 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
17 -May 2012
Signature
54.46 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund