209782 06/18/2012 CITY OF CARMEL, INDIANA VENDOR: 366239 Page 1 of 1
ONE CIVIC SQUARE MONICA HADDOCK CHECK AMOUNT: $109.34
CARMEL, INDIANA 46032 C/O ESE
CHECK NUMBER: 209782
CHECK DATE: 6/1812012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 109.34 TRAVEL FEES EXPENSE
PNrSCXIBED UT SLATE BOARD Or ACCOUNTS GENFJIAL FORM NC. 101 099S)
MILEAGE CLAIM C C IL
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ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, D1JAATW3XT OP INSTITUTION)
SPEEDOMETER
DA, TE FROM TO HEADING AUTO
Z�� NATURE OF BUSINESS MILES
POINT POINT START FINISH TRAVELED PER MILE
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AUTO LICENSE NO. TOTALS R
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 allowing all just credits
and that no part of the same has been paid.
Date
MAY 3 2
012
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.
366239 Haddock, Monica Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
5/24/12 Reimb Mileage 4/19 5/24/12 109.34
Total 109.34
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.
366239 Haddock, Monica Allowed 20
In Sum of
109.34
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -2 Reimb 4343000 109.34 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
14 -Jun 2012
Signature
109.34 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund