220133 05/21/2013 CITY OF CARMEL, INDIANA VENDOR: 363065 Page 1 of 1
r ONE CIVIC SQUARE JAMES DOWELL
CHECK AMOUNT: $307.25
CARMEL, INDIANA 46032 C/0 PARKS-ESE
CHECK NUMBER: 220133
CHECK DATE: 5/21/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 307 . 25 TRAVEL FEES & EXPENSE
RECET-VED
MAY 0 7 2013
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 140.101(1985)
MILEAGE CLAIM
J3 f-=6 9 TO -I'Cne6ba"e
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO,- FOR
(0f,ICE,BOARD,DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER
READING + AUTO MILEAGE
NATURE OF BUSINESS MILES C-i
POINT POINT START FINISH TRAVELED
PER MILE LE
Ace+j!n 1 1-1 q
XIOLO cc,+_0 55 41-"4ul
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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.
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 e,after allowing all just credits,-
and that no part of the same has been paid.
Date
RECFj*\7'TE''D
MAY 0 7 2013
.BY;-
GENERAL FORD 140.101 11986)
PRESCRIBED By STATE BOARD OF ACCOUNTS
MILEAGE CLAIM
PR E S TO C)k-.-) P
(GOVERNMENTAL UNM ON ACCOUNT OF APPROPRIATION NO. — FOR
(OFi7CE,HOARD.DEPAATI@Fi OR OR)
-SPEEDOMETER AUTO
FROM TO READING + NATURE OF BUSINESS WLES MILEAGE
POINT �OTNT START FINISH TRAVELED PER MILE
Lj
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t to C,.LwI 4,e-�
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AUTO LICENSE NO. TOTALS
P
+ 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)ust and correct,that the amount claimed is legally e, ter allowing all )ust credits.-
end that no part of the same has been paid
Date
��b1� 3
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized ratest show-, kind of serfice,units, price performed, dates service rendered, by
whom, rates per day, number of h• r
Payee Purchase Order No.
Terms
363065 Dowell, James
9353 Barcroft Dr, Apt A
Indianapolis, IN 46240
Invoice Invoice Description PO# Amount
Date Number (or note attached invoice(s) or bill(s)) 307.25
5/3/13 Reimb. Mileage 2/18- 5/3/13
Total $ 307.25
1 hereby certify that the attached in 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.
363065 Dowell, James Allowed 20
9353 Barcroft Dr, Apt A
Indianapolis, IN 46240
In Surn of$
$ 307.25
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-3 Reimb. 4343000 $ 307.25 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
16-May 2013
Signature
$ 307.25 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund