221137 06/18/2013 CITY OF CARMEL, INDIANA VENDOR: 365062 Page 1 of 1
ONE CIVIC SQUARE BASEL MAAROUF
CARMEL, INDIANA 46032 13239 MIDDLEWOOD LN CHECK AMOUNT: $21.97
FISHERS IN 46038
CHECK NUMBER: 221137
CHECK DATE: 6/18/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 21 . 97 TRAVEL FEES & EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORM NO.101(1888)
MILEAGE CLAIM O t� / �J na
(GOVERNDIENTAL UNIT))
-��
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD,DEPAA7MENT OA INSTITUTION)
DATE FROM TO SPEEDOMETER
READ + AUTO MILEAGE
POWT POINT START FINISH NATURE OF BUSINESS MILES ® �_ <
TRAVELED PER MILE
an
i
MGUO 'CCG1� <
j 2 7 z.trJ iv T;'CI{ � Ck M ovie J
-2,-4 V�
o na r
Tr�u+i 3.
AUTO LICENSE NO. TOTALS
30o.01 i.9
+ 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 legall y of r al wing all just credits.
end that no part of the same has been paid. � J
Date
on
(T JUN 9 a013
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.
365062 Maarouf, Basel Terms
Invoice AReimb Description
Date r note attached invoices)or bill(s)) PO# Amount
5/29/13 djMiIIeajge5/8 - 5/29/13 $ 21.97
Total $ 21.97
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 5-11-10-1.6
, 20_
Clerk-Treasurer
Voucher No. Warrant No.
365062 Maarouf, Basel Allowed 20
In Sum of$
$ 21.97
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or Board Members
INVOICE NO. ACCT#/TITLE AMOUNT
Dept#
1081-7 Reimb 4343000 $ 21.97 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
13-Jun 2013
P&,—Aknr�
Signature
$ 21.97 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund