212285 08/28/2012 CITY OF CARMEL, INDIANA VENDOR: 366333 Page 1 of 1
ONE CIVIC SQUARE JEFFREY LEE
_. CHECK AMOUNT: $54.11
CARMEL, INDIANA 46032 C/O PARKS
CHECK NUMBER: 212285
CHECK DATE: 8/28/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343000 54 . 11 TRAVEL FEES & EXPENSE
7 X52 e C 1
LA b o 3 Z
°l6,6 - 6661
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FOAM NO.101(1986)
MILEAGE CLAIM
(GOVERNMENTAL UNITI - `J
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD.DEPARTMENT OR INSTITUTION)
SPEEDOMETER
DATE FROM TO READING { — AUTO MILEAGF�
2O I Z NATURE OF BUSINESS MILES C 0•$SS
POINT POINT START FINISH TRAVELED PER MILE
I c�cc sl wnI m _ o ari—�e,�}�✓ — 3 4. 16S
-- D _ Mo tuoln 166 `i 21
b 2 1 ✓ `�• O S
4. los
t V�1 d r�h5 N�uu�AVh 4• 7. `1`I
t�7 rta t�2 7.0 ✓ S 9
7. 5 . 1/
AUTO LICENSE NO. TOTALS �j
+ 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
end that no art i the same has been paid.
Date �� �I�'
AUG 13 2012 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.
366333 Lee, Jeffrey Terms
1452 Trail Creek Ct
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
818112 Reimb Mileage 6/19 -8/2 $ 54.11
Total $ 54.11
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.
366333 Lee, Jeffrey Allowed 20
1452 Trail Creek Ct
Carmel, IN 46032
In Sum of$
$ 54.11
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1082-1 Reimb 4343000 $ 54.11 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
23-Aug 2012
Signature
$ 54.11 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund