217072 02/13/2013 CITY OF CARMEL, INDIANA VENDOR: 360144 Page 1 of 1
ONE CIVIC SQUARE CYNTHIA CANADA
CARMEL, INDIANA 46032 11508 LUCKY DAN DRIVE CHECK AMOUNT: $108.44
NOBLESVILLE IN 46060 CHECK NUMBER: 217072
CHECK DATE: 2/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 108 .44 TRAVEL FEES & EXPENSE
FAISCRIBED BY STATE BOARD OF ACCOUNTS MILEAG E CLAIM �('� �/� GENERAL FORA ac.IQI 0"6)
TO \��
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATIO FOR
(OFiICY,BOARD,DETAAT)NTr OR INSMUNON)
SPEEDOMETER r
DATE FROM TO READING + tTI.IEEOLSED ($ o L tJ r
- POINT POINT START FINISH NATURE OF BUSINESS
PER MILE
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AUTO LICENSE NO. TOTALS Wd 5
+ 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 allowing all just credits
end that n partcof th`e same has been paid.
Date c��� �I 4 =�
1
JAN 21 2013 � L�
PRUCRIBED HT STATr BOARD Or ACCOUNTS GENERAL FORK 110.101(1986)
MILEAGF. CLAIM
TO
(GOVERNMENTAL UNIT) -
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD,DEPARTWXKT OR INsrTTUIION)
DATE FROM TO SPEEDOMETER AUTO MILEAGE
-
NATURE OF BUSINESS POINT POINT START FINISH TRAY LED
PER MILE
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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. V v
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
end that no art of the same has been paid. (�
Date
p 0I
JAN 21 2013 ( I �
-�,(fL� f '�-
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.
360144 Canada, Cyndi Terms
11508 Lucky Dan Dr
Noblesville, IN 46060
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
12/28/12 Reimb Mileage 9/25 - 12/28/12 $ 108.44
Total $ 108.44
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.
360144 Canada, Cyndi Allowed 20
11508 Lucky Dan Dr
Noblesville, IN 46060
In Sum of$
$ 108.44
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-5 Reimb 4343000 $ 108.44 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
7-Feb 2013
e-- �,xflf Aftm--'P'�
Signature
$ 108.44 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund