218535 03/25/2013 CITY OF CARMEL, INDIANA VENDOR: 366990 Page 1 of 1
ONE CIVIC SQUARE JOSH LANE CHECK AMOUNT: $26.79
CARMEL, INDIANA 46032 C/O ESE
CHECK NUMBER: 218535
CHECK DATE: 3/2512013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 26 . 79 TRAVEL FEES & EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORW NO.IIII(1986)
6- MILEAGE CLAIM
TO
CCr- (P^/� GO9ERNAlENTAL UNITI
c- `(` ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD,BOARD,DtPARI.1 OA D78TITUI N)
DATE FROM TO ~SPEEDOMETER
V r 3 READING + AUTO
POINT POINT START FINISH NATURE OF BUSINESS MILES ® s
Wk 1'AAVELED PER MILE
U k �3 I
Cz to '(^ �7
AA1 SS I 2` j• ZtL
LC 2-� L
_ l o •S 1 .
�c 2
�� U �-
1_ 1
gin W y 2.
-
- 13
AUTO LICENSE NO. TOTALS ��7 f_ 7cl V
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. t(J I
Pursuant to the provisions and penalties of Chapter 15S,Acts 1853,I hereby certify that the foregoing account is just and correct,that the amount claimed is lega after allowing all !90,gredits.
end that no a �f t s me has been paid.
Date
MAR 0 8 2013 t
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.
366990 Lane, Josh Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
3/6/13 Reimb Mileage 2/4 -2/28/13 $ 26.79
Total $ 26.79
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
i
Voucher No. Warrant No.
366990 Lane, Josh Allowed 20
In Sum of$
$ 26.79
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or Board Members
Dept# INVOICE NO. ACCT#/TITLE AMOUNT
1081-11 Reimb 4343000 $ 26.79 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-Mar 2013
Signature
$ 26.79 _ Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund