219277 04/24/2013 *f CITY OF CARMEL, INDIANA VENDOR: 367093 Page 1 of 1
` ONE CIVIC SQUARE ALYSSA CLARK CHECK AMOUNT: $37.05
o CARMEL, INDIANA 46032 C/O PARKS
CHECK NUMBER: 219277
CHECK DATE: 4/24/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 37 . 05 TRAVEL FEES & EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 140.101(1986)
Cc C MILEAGE CLAIM
TO
(GOVERNMENTAL 1JN1T)
ON ACCOUNT OF APPROPRIATION NO. FOR
COH-ICE,BOARD.DEPARTMENT OR INSTITUTION)
SPEEDOMETER
DATE FROM TO READING AUTO MILEAGE
+ NATURE OF BUSINESS MILES @
POINT POINT START FINISH TRAVELED 6
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MCC
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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. :37,0
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 n:q,6the same has been paid,
Date L3 0,1"L
`�
IAPR 15 2013
Bv--
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.
Clark, Alyssa Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
4/10/13 Reimb Mileage 11/12/12 -4/10/13 $ 37.05
I
Total
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.
Clark, Alyssa Allowed 20
In Sum of$
$ 37.05
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or Board Members
Dept# INVOICE NO. ACCT#/TITLE AMOUNT
1081-04 Reimb 4343000 $ 37.05 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
18-Apr 2013
Signature
$ 37.05 _ Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund