211654 08/14/2012 CITY OF CARMEL, INDIANA VENDOR: 366471 Page 1 of 1
0 ONE CIVIC SQUARE SHANDI BRAY
CARMEL, INDIANA 46032 C/O PARKS CHECK AMOUNT: $6.11
CHECK NUMBER: 211654
CHECK DATE: 8114/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343000 6 . 11 TRAVEL FEES & EXPENSE
PRESCRIBED By STATE BOARD OF ACCOUNTS CENTRAL FORM 110.IDI(In9
MILEAGE CLAIM
CL P�Q, TO
(GOVERNMENTAL UNITI
ON ACCOUNT OF APPROPRIATION NO. FOR
tOFICE,BOARD,DEYAAT1(LtfT OR INSRTUTION)
SPEEDOMETER AUTO MILEAGE
DATE FROM TO READING + NATURE OF BUSINESS MILES ap 17.5
POINT POINT START FINISH TRAVELED PER MILE
mono7l 4 U
--
Ci,,r c c,i nor-\----- w r-,( Y�
AUTO LICENSE NO. TOTALS I I '
+ 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 pa of k a lama has been paid. /f
Date / 31a `
6q�
"�A i 082082012
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.
Bray, Shandi Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
8/3/12 Reimb Mileage 7/13 - 8/2/12 $ 6.11
Total $ 6.11
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.
Bray, Shandi Allowed 20
In Sum of$
$ 6.11
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#[TITLE AMOUNT Board Members
Dept#
1082-1 Reimb 4343000 $ 6.11 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
9-Aug 2012
N. SLJ
Signature
Is 6.11 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund