211664 08/14/2012 \,f CITY OF CARMEL, INDIANA VENDOR: 360144 Page 1 of 1
ONE CIVIC SQUARE CYNTHIA CANADA CHECK AMOUNT: $133.08
CARMEL, INDIANA 46032 11508 LUCKY DAN DRIVE
NOBLESVILLE IN 46060 CHECK NUMBER: 211664
CHECK DATE: 8/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 90 . 57 TRAVEL FEES & EXPENSE
1082 4343000 42 . 51 TRAVEL FEES & EXPENSE
1
PRPSCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM IIC.191 11986)
MILEAGE CLAIM
TO o to i n C--
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
_ i I
(OF.10E,BOARD,DEPABTa7?08 INSrMJEJON) I
FROM I TO SPEEDOMETER AUTO NZEAGE
DATE READING
NATURE OF BUSINESS MILES (ty
POINT POINT START FINISH TRAVELED PER MILE
---- n 3_ -- —
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2, -
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AUTO LtCENSE NO. TOTALS
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+ 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 1953,1 hereby certify that the foregoing account is just and correct,that the amount claimed is legally due,after allowing all just credits
end that o part 11 tale a has been paid.
Date
2012
JUL 2 5
PMCRIe ED By STATE BOARD OF ACCOUNTS GENERAL FORM NG.101(19es)
MILEAGE CLAIM
O
T Can n
_
(DOVEANMENTAL uNIn ON ACCOUNT OF APPROPRIATION NO. FOR
(Ofi7CE,BOARD,DEPART14Nr OR INSTrrULION)
FROM TO SPEEDOMETER AUTO AG
DATE READING NATURE OF BUSINESS MILES lei r S
2� pp�T POINT START FINISH iAAVELfiD PER MILE
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D a f zor, n
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e sk
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rte_
C_r< 12 m i n Ce-
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- nccr n I L4
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Lill \ ? C v -
< c6s 17n,
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 aliowing all just credits
end that n part f the same has been paid. �..-
ii 1 1
Date l
JUL 2 5 2012
p
,l
y
PRESCRIBED By STATE BOARD OF ACCOUNTS GENFAAL FORM 110 101(1986)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT) --
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF,ICP,BOARD,DEPARTMENT OR 1NSTIMiON)
DATE FROM TO SREADINGETER AUTO M IUAG£
2.8- POINT POINT START FINISH NATURE OF BUSINFS6 TRAVELED
PER MILE
W e.
U? 1 vJ fY1 :2
c.
Lo c r
A 19b t �
i�v f A-0 C=ccT�
LO Al --
f
r
US Z2.CF-
_--
t2 175 1
FS
-- L'
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 1953,1 hereby certify that the foregoing account is just and correct,that the amount claimed is legally due,after allowing all just credits
end that no part oft a same has been paid.
t
Date 7 c,
J JUL
UL 2 5 2012
BY:
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.
360144 Canada, Cyndi Terms
11508 Lucky Dan Dr
Noblesville, IN 46060
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
7/13/12 Reimb Mileage 3/16 - 5/31/12 $ 90.57
7113/12 Reimb Mileage 6/5 -7/10/12 $ 42.51
Total $ 133.0$
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.
360144 Canada, Cyndi Allowed 20
11508 Lucky Dan Dr
Noblesville, IN 46060
In Sum of$
$ 133.08
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or Board Members
Dept# INVOICE NO. ACCT#/TITLE AMOUNT
1081-5 Reimb 4343000 $ 90.57 1 hereby certify that the attached invoice(s), or
1082-2 Reimb 4343000 $ 42.51 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
�0&&Mjw-)
Signature
$ 133.08 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund