215326 12/11/2012 �,. CITY OF CARMEL, INDIANA VENDOR: 365463 Page 1 of 1
ONE CIVIC SQUARE MATTHEW GREGORY
CARMEL,INDIANA 46032 C/O ESE CHECK AMOUNT: $101.25
CHECK NUMBER: 215326
Miro_io`
CHECK DATE: 12/11/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 101 . 25 TRAVEL FEES & EXPENSE
PRESCRIBED BY STATE HOARD OF ACCOUNTS GENERAL FOAH 140.101 ttnbl
MILEAGE CLAIM
TO / LLL ii�LLL
tOOVEANNCNTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD,DE?AAT1@(r OR 1NSTIMI0N)
FROM TO SPEEDOMETER AUTO WLE&GE
DATE READING +
F
NATURE OF BUSINE56 MILES
Zo POINT POINT START FINISH TRAVELED PER MILE
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AUTO LICENSE NO. TOTALS
+ SPEEDOMETER READING columns ere to be used cnly 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
and that no part of the same has been paid.
Date ' , _ -7—/.t,
F BY: WED
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.
365463 Gregory, Matthew Terms
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
11/27/12 Reimb Mileage 10/17 - 11/27/12 $ 101.25
Total $ 101.25
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$
$ 101.25
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-7 Reimb 4343000 $ 101.25 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
6-Dec 2012
Signature
$ 101.25 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund