213494 10/09/2012 CITY OF CARMEL, INDIANA VENDOR: 364243 Page 1 of 1
0 ONE CIVIC SQUARE JORDAN HILL CHECK AMOUNT: $85.80
/+ CARMEL, INDIANA 46032 21477 ANTHONY RD
o; NOBLESVILLE IN 46062 CHECK NUMBER: 213494
CHECK DATE: 101912012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 85 . 80 TRAVEL FEES & EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS ED"FORM 110.101(198)
MILEAGE CLAIM �ra,� P2f OJ eCvN
Ec•�tr,cEecE Sc.�oo 1 �rl ntl�m r n a- ro
/� (OOVn1NMENJAIUN /� [
G(G.l ParKS Rec-mk kvn ON ACCOUNT OF APPROPRIATION NO. )IQ 049 f
FOR z
(0FF1C{BOARD.DEPAATWINT OR N6nTLMON)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING +
ZO ";t- NATURE OF BUSINESS I.IILES a r
POINT POINT START FINISH TRAVELED PER MILE
iS Woo
wo 1 /to (bo< Mono" 1.(.5_
$IJi� { Coo non Ad one in r - F ry 5
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AUTO LICENSE NO. TOTALS g ya CJ
+ 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 dun, iter aliowing all just credits
end that no part of the same has been paid.
Date
d •4 �` 'r��'J"J
OCT 0 12012
BY'—
r ..n
MIMI ME
_ 0,85W-•!.
rM
' ��I .•.•. '+1L• ► r --Iii..«.. ilL'i�a�-I�I�
,ems±.
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show;knumbe service,
units, price pe0unit dates service rendered, by
l
whom,rates per day, number of hours, rate per hour,
Payee Purchase Order No.
Terms
364243 Hill, Jordan
Invoice Description PO# Amount
Invoice (or note attached invoice(s) or bill(s))
Date Number $ 85.80
9120112 Reimb Mileage 2110 -9120/12
Total $ 85.80
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.
364243 Hill, Jordan Allowed 20
In Sum of$
$ 85.80
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. A.CCT#/`TITLE AMOUNT Board Members
Dept#
1081-11 Reimb 4343000 $ 85.80 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
4-Oct 2012
>&1h' WY'r1Z pot
Signature
$ 85.80 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund