215960 01/09/2013 CITY OF CARMEL, INDIANA VENDOR: 366013 Page 1 of 1
ONE CIVIC SQUARE DAWN ARMBRUSTER
CARMEL, INDIANA 46032 C/O ESE CHECK AMOUNT: $50.45
CHECK NUMBER: 215960
CHECK DATE: 1/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 50 .45 TRAVEL FEES & EXPENSE
DEC 19 2012
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORD DO.101(1906)
MILEAGE CLAIM
Dawn TO
(GOVERNMENTAL UNI'n -
ON ACCOUNT OF APPROPRIATION NO. FOR
(O"CE,BOARD,DEPART 3D(T OA 1NSr1M1ON)
DATE FROM TO SPEEDOMETER AUTO+ AMILES (y
NATURE OF BUSINESS
2J 1a POINT POINT START FINISH TRAVELED PER MILE
ate M-c---CAr/L_ V 3.l I It
_—I/a mom-- s --- ca.2 ---- -
3 ,r•nT- � —
Z k A cr—C —.— LQ
4))c
CD
Q !9q 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,I hereby certify that the foregoing account is just and correct,that the amount claimed is lega du ,after a'ow' g all just credits
end that no pa of the ame has been paid.
Date �' 0 ��
L .............
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.
366013 Armbruster, Dawn Terms
2270 Pinckney Rd
Howell, MI 48843
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
11/7/12 Reimb Mileage 1/26 -6/1/12 $ 50.45
Total $ 50.45
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.
366013 Armbruster, Dawn Allowed 20
2270 Pinckney Rd
Howell, MI 48843
In Sum of$
$ 50.45
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-5 Reimb 4343000 $ 50.45 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
3-Jan 2013
Signature
$ 50.45 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I
I