213022 09/25/2012 ��. CITY OF CARMEL, INDIANA VENDOR: 365463 Page 1 of 1
ONE CIVIC SQUARE MATTHEW GREGORY
CARMEL, INDIANA 46032 C/O ESE CHECK AMOUNT: $105.30
CHECK NUMBER: 213022
CHECK DATE: 9/25/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 105 . 30 TRAVEL FEES & EXPENSE
PRESCRIBED BT STATE BOARD Or ACCOUNTS M0L+tk 'tW GENERAL FORA I1O.101 IWBF)
MILEAGE CLAIM G �r� p j�ro__
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO- FOR
(OF,-=.BOARD.DEPARTHrNT OR INSrDIMC)N)
pF SPEEDOMETER AUTO ([LN-
2 DA FROM TO BEADING + 1+�•
�_ POINT POINT START FINISH NATURE OF BUSINESS �
TRAVELED PER MILE
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AUTO LICENSE NO. TOTALS I I 0 C1.$O
+ 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
SEP 17 2012
a r,
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.
Terms
365463 Gregory, Matthew
Invoice Invoice Description PO# Amount
Date Number (or note attached invoice(s)or bill(s))
$ 105.30
9/14/12 Reimb Mileage 8/9 -9/13/12
Total $ 105.30
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.
365463 Gregory, Matthew Allowed 20
In Sum of$
$ 105.30
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-7 Reimb 4343000 $ 105.30 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
20-Sep 2012
Signature
$ 105.30 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund