222064 07/17/2013 CITY OF CARMEL, INDIANA VENDOR: 366990 Page 1 of 1
ONE CIVIC SQUARE JOSH LANE
CARMEL, INDIANA 46032 C/O ESE CHECK AMOUNT: $26.40
CHECK NUMBER: 222064
CHECK DATE: 7/17/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 26 .40 TRAVEL FEES & EXPENSE
JUN 21 2013
PRESCRIBED BY STATE BOARD OF ACCOUNTS
BY:Y: UMAX.FORT!NO.101(1486)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT)
lcz to 0- ON ACCOUNT OF APPROPRIATION NO. FOR Gy&-A-#
(OFFICE.BOARD.DEPARTMENT OR IN8TMJT1CiWJ
DA FROM TO SPEEDOMETER
yj READING + AUTO MI�AGE
POINT POINT 3TAAT FINISH NATURE OF BUSINESS MILES ® § E t
TRAVELED PER MILE
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AUTO LICENSE NO. TOTALS [� 1 O
+ SPEEDOMETER REEDING columns are to be used only when distance between points cannot he 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 due,after allowing all just credits
end that no part of the satmg has been paid.3J
Date iff �l 131413
� P
II
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
6/13/13 Reimb Mileage 5/1 - 5/30/13 $ 26.40
Total $ 26.40
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.
366990 Lane, Josh Allowed 20
In Sum of$
$ 26.40
y
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or Board Members
Dept#
INVOICE NO. CCT#/TITL AMOUNT
1081-11 Reimb 4343000 $ 26.40 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
' Y which charge is made were ordered and
received except
10-Jul 2013
Signature
$ 26.40 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund