215609 12/18/2012 CITY OF CARMEL, INDIANA VENDOR: 360074 Page 1 of 1
ONE CIVIC SQUARE SUE COY
CARMEL, INDIANA 46032 C/O HUMAN RESOURCES CHECK AMOUNT: $31.08
ONE CIVIC SO CHECK NUMBER: 215609
CARMEL IN 46032
CHECK DATE: 12/18/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4343002 12 . 17 . 12 31 . 08 EXTERNAL TRAINING TRA
�nt3
Prescribed by State Board of Accounts
p� 1 p �+p p p� General Form No.107(1955)
6V ILEAGE ClLAI1Vi
C f TO �lJQ 'LUO l 'c�CA-V1 c� o`t DR.
;Governmental Unit)( U
On Account of Appropriation No. for
(Office,Board,Department or Institution
DATE FROM TO
2�I ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE @ rJ�
Point Point Start Finish TRAVELED PER MILE
5 r* , 9
/a/ CAP
LvrG(
fa i f O
tj
Auto License No. TOTALS 00, �/ Qg
* 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 1,55, 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 � %// 1-- r L,t>a ? Cl_G
U U
Claim No. Warrant No. I have examined 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 Offioer
(D
Allowed 20 (DD t=- o
in the sum of$ 0 (D•
N ¢'(QD
0 E✓
(D
0 0
�
�,M•t R.
(Board of Commission)
FILED
R (D
n
O
�, fL
n cC2
(D (D
(D
L Ei.
(Official Title)
l 0
VOUCHER NO. WARRANT NO.
ALLOWED 20
Coy, Sue i
I IN SUM OF $
Employee
$31.08
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1201 12.17.12 43-430.02 $31.08
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, December 17, 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))
12/17/12 12.17.12 mileage 12.4.12-12.13.12 $31.08
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