212009 08/14/2012 CITY OF CARMEL, INDIANA VENDOR: 366462 Page 1 of 1
ONE CIVIC SQUARE ANNA YU
CARMEL, INDIANA 46032 C/O ESE CHECK AMOUNT: $25.64
CHECK NUMBER: 212009
CHECK DATE: 8/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343000 REIMB 25 . 64 TRAVEL FEES & EXPENSE
-Am-a
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO.101(1986)
MILEAGE CLAIM
TO
(GOVERNMENTAL U14171 ON ACCOUNT OF APPROPRIATION No,- FOR
(OFFICE,BOARD.DEPARTIMa OR INSTITUTION)
DATE FROM TO SPEEDOMETER
READING + AUTO
20 -- NATURE OF BUSINESS MILES VAT C
POINT POINT START FINISH TRAVELED
PER MILE
C-rQ0 0 U P Noon �Olktvr S.L"Ryi—MU]'
ani)
kSd-q L,- A
JWLA Z6 ---K-
Kwir
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 aliowing all just credits
and that no part of the Same has been paid.
Date
RESET DIED
JUL 31 2012
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.
Yu, Anna Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
7127/12 Reimb Mileage 5/30 -7/26/12 $ 25.64
Total $ 25.64
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.
Yu, Anna Allowed 20
In Sum of$
$ 25.64
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1082-1 Reimb 4343000 $ 25.64 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
Signature
$ 25.64 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund