219398 04/24/2013 a� ,F CITY OF CARMEL, INDIANA VENDOR: 366990 Page 1 of 1
ONE CIVIC SQUARE JOSH LANE
CARMEL, INDIANA 46032 C/O ESE CHECK AMOUNT: $33.06
CHECK NUMBER: 219398
'TOM GO
CHECK DATE: 4/24/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 33 . 06 TRAVEL FEES & EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORM NO.101(1988)
MILEAGE CLAIM
L./
5 L TO
(GOV ENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR G{ —
(OFFICE,BOARD,DEPARTMENT OR 1NSTITU7ION)
DATE FROM TO SPEEDOMETER READING .{-
AUTO MILEAGE
.7e
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED MILES ® —K-6-f�
PER MILE
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AUTO LICENSE NO. TOTALS 58.51
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. -; 3
Pursuant to the provisions and penalties of Chapter 1SS,Acts 1953,I hereby certify that the foregoing account is just and correct, tliat.the amount claimed is legally due,after alfowin 'ust credits
end that no part of the same has been paid.
Date
I'll 5 2013
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
4/9/13 Reimb Mileage 3/1 -4/9/13 $ 33.06
i
Total j$ 33.06
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.
366990 Lane, Josh Allowed 20
In Sum of$
$ 33.06
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-11 Reimb 4343000 $ 33.06 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
I
`ea�
&A&m.P-Kw-
Signature
$ 33.06 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund