217164 02/13/2013 CITY OF CARMEL, INDIANA VENDOR: 366940 Page 1 of 1
ONE CIVIC SQUARE NICHOLE HABERLIN
s CHECK AMOUNT: $141.02
CARMEL, INDIANA 46032 CIO PARKS
CHECK NUMBER: 217164
CHECK DATE: 2/1312013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4343000 REIMB 141 . 02 TRAVEL FEES & EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 80.101(1986)
MILEAGE CLAIM 1 r I,,JTi -
TO- LE— �i u Ttr1
(GOVERNMENTAL UNIT) -
ON ACCOUNT OF APPROPRIATION NO.. FOR.
(OFFICE,BOARD.DEPARTMENT OR INSTITUTION) _
D T FROM TO j SPEED014 ETi4 �r
L'i.lG { AUTO GE
AEi
NATURE OF BUSINESS MILES pE a
POINT ,
'POINT � START � FINISH TRAVELED pEA MI
-
-
--+ -
--; -- ...
-- .____�
AUTO LICENSE NO. p,A' 7 Z �{M�I� S l TOTALS 1_
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. !�J
Pursuant to the provisions and penalties of Chapter 155,Acts 1953,1 hereby certify that the foregoing account is just and correct,that the amount claimed is.legally due,after allowing 11 just credits
and that no part of the same has been paid. 4 l - _
Date -- 12 1• 4a YA l L4 V h� 16&*
115
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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.
Haberlin, Nichole Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
1/18/13 Reimb Mileage 1/15 - 1/16/13 $ 141.02
<: Total $ 141.02
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.
Haberlin, Nichole Allowed 20
In Sum of$
$ 141.02
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1091 Reimb 4343000 $ 141.02 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
I
I
7-Feb 2013
Signature
$ 141.02 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund