220233 05/21/2013 CITY OF CARMEL, INDIANA VENDOR: 366990 Page 1 of 1
ONE CIVIC SQUARE JOSH LANE
CARMEL, INDIANA 46032 C/O ESE CHECK AMOUNT: $25.18
CHECK NUMBER: 220233
CHECK DATE: 5121/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 25 . 18 TRAVEL FEES & EXPENSE
MAY 4 Z 7013
PRESCRIBED BY STATE HOARD OF ACCOUNTS
BY:
GENERAL FORM NO.101(1986)
MILEAGE CLAIM
TO
(GOVERN TAL UNIT)
G 6- R ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD,DEPARTMENT OR 1NHTITUT ON)
FROM SPEEDOMETER
DATE TO i READING + AUTO MILEAGE
POINT POINT START FINIS NATURE OF BUSINESS TRAVELED g(U$' ¢
PER MILE
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— AUTO LICENSE NO. �— TOTALS N' I
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. �tJ
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 i y due,after allowing a ust c edits
and that no part of the same has been paid.
Date
e- 11-qm304
rem
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.
Terms
366990 Lane, Josh
Invoice Invoice Description Amount
or note attached invoice(s) or bill(s)) PO#
Date Number ( $ 25.18
4/30/13 Reimb Mileage 4/9-4/30/13
Total $ 25.18
1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
with IC s-11-10-1.6
120_
Clerk-Treasurer
Voucher No. Warrant No.
366990 Lane, Josh Allowed 20
In Sum of$
$ 25.18
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or Board Members
Dept# INVOICE NO. CCT#/TITL AMOUNT
1081-11 Reimb 4343000 $ 25.18 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
$ 25.18 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund