209834 06/18/2012 f CITY OF CARMEL, INDIANA VENDOR: 364943 Page 1 of 1
ONE CIVIC SQUARE VICKI RUBIO CHECK AMOUNT: $50.57
CARMEL, INDIANA 46032
CHECK NUMBER: 209834
CHECK DATE: 6/1812012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 50.57 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORM IIG. 101 (1986)
MILEAGE CLAIM
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFiICE, BOARD, DEPARTM}7rT OR INSTC TION)
SPEEDOMETER AUTO MILEAGE
DA FROM TO I READING
Z� POINT POINT START FINISH NATURE OF BUSINESS TRAVELED ED ER 5
T
PER MILE
UA
1 CA. W
Y^ S
C.
1
I
AUTO LICENSE NO.
TOTALS
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 alio all just cred"
end that no p art of the has been paid.
Date
�1 I
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
5/24/12 Reimb Mileage 5/2 5/24/12 50.57
Total 50.57
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
50.57
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TlTLE AMOUNT Board Members
Dept
1081 -3 Reimb 4343000 50.57 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
50.57 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund