216794 01/29/2013 CITY OF CARMEL, INDIANA VENDOR: 365062 Page 1 of 1
ONE CIVIC SQUARE BASEL MAAROUF CHECK AMOUNT: $12.59
CARMEL, INDIANA 46032 13239 MIDDLEW000 LN
FISHERS IN 46038 CHECK NUMBER: 216794
CHECK DATE: 1/29/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 12 . 59 TRAVEL FEES & EXPENSE
9'-)aS6a�
PRESCRIBED BT STATE BOARD OF ACCOUNTS I GENERAL FORM NO 101 11996)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIn
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD,DEPAATWXKT OR INSIT UTION)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING +f NATURE OF BUSINESS MILES (g CjC)cj c
POINT POINT START FINISH TRAVELED PER MILE
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 legally due,after aliowing all lust credits
and that no part of the same has been paid.
Date
no
JAN
� 0 7 2013
BY
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.
365062 Maarouf, Basel Terms
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
12/19/12 Reimb Mileage 12/19/12 $ 12.59
Total $ 12.59
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.
i
I
365062 Maarouf, Basel Allowed 20
4 In Sum of$
$ 12.59
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-7 Reimb 4343000 $ 12.59 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
24-Jan 2013
Signature
$ 12.59 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
s