214604 11/20/2012 CITY OF CARMEL, INDIANA VENDOR: 360074 Page 1 of 1
` ONE CIVIC SQUARE SUE COY CHECK AMOUNT: $125.43
CARMEL, INDIANA 46032 C/O HUMAN RESOURCES
ONE CIVIC SO CHECK NUMBER: 214604
CARMEL IN 46032
CHECK DATE: 11/20/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4343002 11 . 19 . 12 125 .43 EXTERNAL TRAINING TRA
Prescribed by State Board of Accounts MILEAGE ;' LAI iW General Farm No.101 (1955)
j�
0,�" GLV m e TO DR.
(Govern ntal nit) &)- y e-S-0 .lam(L(2 S On Account of Appropriation No. for ' uUe
ice,Boar ,Department or Institution
DATE FROM TO 5
ODOMETER READING NATURE OF BUSINESS AUTO MILES MILEAGE @ 9
ZD tt Point Point Start Finish TRAVELED PER MILE
104 .�f GUsz "ss ,r)n M —OT- .zY
t ra zorz Cct 'SAzsEt Q110t 12
r
/-7 r =C-ate a t 5 ��r,v,n Co- z� ( a s /Y�/ bbC y
bell
r r met c�et o
4� 1911 r )
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1 " it
1 �a Cti e t i U
1/S
V 1d _ 2 — I I L
If g WaIZA I �c
to C1
!o r o Fcp !r - ,,
c x YYLY
/o 3o Q lL
. 1
Auto License No. TOTALS
' 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
allowing all just credits, and that no part of the same has been paid.
Date / I %Ct
G�
Claim No. Warrant No. I have exarni.ned the within claim and
hereby certify as follows:
IN FAVOR OF
That it is in proper form;
That it is duly authenticated as required
by law;
That it is based upon statutory authority;
That it is apparently correct
$ incorrect
On Account of Appropriation No. for
Disbursing Officer
M
Allowed 20 (D o
in the stun of$ o
m
(D
Q � rE
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m
N (D
0
(Hocad or Commission) I ; (a O
D
FILED CD
R � o
a m
o
CD Q
�w N
m
(Official Title)
9 D M
O M
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Coy, Sue
IN SUM OF $
Employee
$125.43
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO#/Dept. INVOICE NO. ACCT#/TITLE F AMOUNT Board Members
1201 11.19.12 43-430.02 $125.43 I 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
Monday, November 19, 2012
Director, HR
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or 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
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
11/19/12 11.19.12 Mileage Claim $125.43
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