217774 02/26/2013 CITY OF CARMEL, INDIANA VENDOR: 366983 Page 1 of 1
ONE CIVIC SQUARE ALEX PELTON
CARMEL, INDIANA 46032 C/O ESE CHECK AMOUNT: $4.44
CHECK NUMBER: 217774
CHECK DATE: 2/26/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 4 .44 TRAVEL FEES & EXPENSE
GENERAL FORM 110.IOJ(1986)
PRESCRIBED BY STATE BOARD OF ACCOUNTS
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
SPEEDOMETER - AUTO nEA-G
FROM TO READING + MILES
DATE NATURE OF BUSINESS TRAVELED PER MILE
POINT POINT START FINISH
----------
AUTO LICENSE NO. TOTALS
+ SPEEDOMETER READING columns are to be used only when distance between point-,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 legally due,after allowing all just credits
and that no part of the same has been paid.
Date 00
DVL '-)( f
7
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.
Pelton, Alex Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
2/7/13 Reimb Mileage 12/10/12 $ 4.44
Total $ 4.44
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.
Pelton, Alex Allowed 20
In Sum of$
$ 4.44
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#[TITLE AMOUNT Board Members
Dept#
1081-10 Reimb 4343000 $ 4.44 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
j which charge is made were ordered and
received except
21-Feb 2013
q I A A41
j�L-Z 4
Signature
Is 4.44 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
a