213929 10/23/2012 CITY OF CARMEL, INDIANA VENDOR: 366663 Page 1 of 1
`` `• ONE CIVIC SQUARE AMANDA GILLIM
1 � CHECK AMOUNT: $60.24
CARMEL, INDIANA 46032 C/0 PARKS
CHECK NUMBER: 213929
CHECK DATE: 10/23/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 60 . 24 TRAVEL FEES & EXPENSE
PRESCRIBED BY STATr BOARD OF ACCOUNTS GENFJIAL FORM NO.101(1984
MILEAGE CLAIM
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO.. FOR
(OFFICE,BOARD,DEPART4Z(T OA INSTnUrION)
SPEEDOMETER
D FROM TO READING * AUTO el •Pf� c
NATURE OF BUSINESS
POINT POINT START FINISH TRAVELED PER MILE
1A1 r
Z
Z
12, L -- .D
l -
CX btclL
1
T Lt -4
10 _ --
t M
1
(� PA U,
Ll
'l•
ST 11 MT
.'/
Zy Ue
Z1 3.4
.n _.._
im
^ p
AUTO LICENSE NO.
'V�jI L� TOTALS 10U G4 �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 th provisions and penalties of Chapter 155,Acts 1953,I hereby certify that the foregoing account is just and correct,that the amount c mad i legally due,after aliow 9 credits
end that o a o th same has been paid
Date
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.
Gillim, Amanda Terms
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
9/18/12 Reimb Mileage 7/19 -9/5/12 $ 60.24
Total $ 60.24
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.
Gillim, Amanda Allowed 20
In Sum of$
$ 60.24
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. A.CCT#/TITL AMOUNT Board Members
Dept#
1081-5 Reimb 4343000 $ 60.24 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
18-Oct 2012
Signature
$ 60.24 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund