213162 09/25/2012 CITY OF CARMEL, INDIANA VENDOR: 364943 Page 1 of 1
ONE CIVIC SQUARE VICKI RUBIO CHECK AMOUNT: $46.68
CARMEL, INDIANA 46032
CHECK NUMBER: 213162
CHECK DATE: 9125/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 46 . 68 TRAVEL FEES & EXPENSE
PRESCRIBED By STATE BOARD Of ACCOUNTS GENERAL FORM I/C.101(1986)
MILEAGE CLAIM
L1I '— o
—
° (GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(Oii10E,BOARD.DFPARTY}Nr Ofl INSTrrUriON)
SPEEDOMETER AUTO
DATE FROM TO I READING + MILES 4 c
Zo START FINISH NATURE OF BUSINESS
TRAVELED
POINT POINT PER MILE
f3 C(}
C.C-
1 W
C
-LA)
-- — C
g ---
i
AUTO LICENSE NO. TOTALS L-1 I-i6 60 �
+ 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 no part of the same has been paid. \
Date �U -
SEP072012 I �/ v SEP072012
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.
364943 Rubio, Vicki Terms
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
8/31/12 Reimb Mileage 8/7 -8/31/12 $ 46.68
Total $ 46.68
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.
364943 Rubio, Vicki Allowed 20
In Sum of$
$ 46.68
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-3 Reimb 4343000 $ 46.68 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
\6 bylmm m "
Signature
$ 46.68 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund