220170 05/21/2013 CITY OF CARMEL, INDIANA VENDOR: 366663 Page 1 of 1
ONE CIVIC SQUARE AMANDA GILLIM
i 11' CHECK AMOUNT: $102.74
,. +a CARMEL, INDIANA 46032 C/O PARKS
CHECK NUMBER: 220170
CHECK DATE: 5/21/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 102 . 74 TRAVEL FEES & EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS ` GENERAL FORM 11c.101 t)"s)
MILEAGE CLAIM 4W
(GOVERTIMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD,DEPAATM3XT OR INSTrnTrION)
�D FROM TO SPEEDOMETER READING * AMILES ® HnjEAG�= C
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED PER PEA MI[-E
214 MIr Cc --- Mtu�kt 2
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LtA
1 T CC O •� `�2
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41- "— Z
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2 :2 PM4 C I n^
L]Et iAC vrtents
AUTO LICENSE NO- 1 J� l .� 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,I hereby certify that the foregoing account is just and correct,that the amount claimed is 1 golly due,after allow' lust credits
end that no p rt of t e same has been paid.
Date 1 J
APR 19 2013
FtZ�.
PMSCRISED MY STATE SOAX0 OF ACCOUNTS MHERAL WNW C; 1MtIWEI
MILEAGV CLAIM &t (11M
ON ACCOUNT OF APPROPRIATION NO. FOR
tO;710E,BOARD.DEMRTWINT OA INSUTUTIOR)
AUTO WLTJLGE
D A Tl.� FROM TO READING 4� it NATURE OF BUSINESS MILES
V-3 TRAVELED
FOPIT POINT S-,ALRT NISH PER MIL--
CIC
CO-
Iq
K
f
P 6tAAA_0AA
A—tc_c
LC--
-f-- a*11,1 AAXA
i�A 4 C
' AA C-e-
-71
---pul 4-
AUTO LICENSE NO. C51 C)?) A ✓
+ SPEEDOMETER READING columns are to be used only when distance between points cannot he determined by iixed mileage or official highway nap.
Parrmartf to the provisions and penalties of Chapier 155,Acts 1953,1 hereby CLTtity that the foregoing account is just and--0:recf.that the amoun 'mad is legally due,after aliowi g all l st credits
end that no part of flie Same has been paid
Date
[APR 19 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.
366663 Gillim, Amanda Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
4/17/13 Reimb Mileage 1/15 - 4/17/13 $ 102.74
Total $ 102.74
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.
366663 Gillim, Amanda Allowed 20
In Sum of$
$ 102.74
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or Board Members
Dept#
INVOICE NO. CCT#/TITL AMOUNT
1081-5 Reimb 4343000 $ 102.74 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
$ 102.74 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund