217656 02/26/2013 .f CITY OF CARMEL, INDIANA VENDOR: 366940 Page 1 of 1
ONE CIVIC SQUARE NICHOLE HABERLIN
' CARMEL, INDIANA 46032 C/O PARKS CHECK AMOUNT: $29.95
'* r� CHECK NUMBER: 217656
CHECK DATE: 2/26/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4343000 REIMB 29 . 95 TRAVEL FEES & EXPENSE
G9NFRA1 FORM NO,101(1986)
PRESCRIBED BY STATE BOARD OF ACCOUNTS
MILEAGE CLAIM
Mee TO_ Nte'�0(0 L
�Wm elm for
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO.- FOR
(OFFICE,BOARD.DEPARTMENT OR INSTITUTION)
_§P_CE_DOMff1ff_ AUTO
DATE FROM TO
._READING Ss MILES
T_
NATURE OF BUSINE
�0_L2,_ POINT START TRAVELED PER MILE
POINT
crr
U
It ft 14 . 97 -'
------------------------
.............
- --------------------------
---------------------
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 1953,1 hereby certify that the foregoing account is just and correct,that the amount claimed is leg 11 due after alio all just credits,
ft end that no part of the same has been paid.
Date zo(
FES 72013J
o Coiitinue in Learn to Swim Level 1 o Move to Learn to Swim Level 2
Key:
,Excellent D: Developing N/C: Not Completed
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
2/5/13 Reimb Mileage 1/28/13 $ 29.95
Total Is 29.95
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.
Haberlin, Nichole Allowed 20
In Sum of$
$ 29.95
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
QO#or Board Members
Dept# INVOICE NO. ACCT#[TITLE AMOUNT
1091 Reimb 4343000 $ 29.95 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
21-Feb 2013
Signature
$ 29.95 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
c