222335 07/30/2013 �F CITY OF CARMEL, INDIANA VENDOR: 360144 Page 1 of 1
ONE CIVIC SQUARE CYNTHIA CANADA
CARMEL, INDIANA 46032 11508 LUCKY DAN DRIVE CHECK AMOUNT: $156.95
' NOBLESVILLE IN 46060 CHECK NUMBER: 222335
ATOM�
CHECK DATE: 7/30/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 106 . 22 TRAVEL FEES & EXPENSE
1082 4343000 50 . 73 TRAVEL FEES & EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO.101 JIM)
MILEAGE CLAIM
�
(GOVERNMENTAL UNIT) 1
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD.DEPARTT4N7 OR DISTITMION(
D
FROM TO SPEEDOMETER
READING a AUTO MILEAGE
z0 NATURE OF BUSINESS MILES 4„5[p
POINT POINT START FtNISN TRAVELED PER MILE
P
�r� -
am M P
L � lb
C._
cC_
I
C-yy) ,- c
r, 19 a. C Ph
C m n
rte_ c•
-- 3
LC_
AUTO LICENSE NO. TOTALS
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155,Acts 1953,1 hereby certify that the lorogoing account is just and correct,that the amount claimed is legally due,after allowing all just credits.
and that n art of s ma has been paid.
Date 11� I _ v q,-s
I �
/
"==�BY STATE ZOAKD",="OUWM ==°=== M 1.9SE1
MILEAGE CLAIM C, '
TO
-----T--
`~~`~~^~'^^~'~ ow ACCOUNT us APPROPRIATION NO. -___--_ FOw —_
,^...BOARD.~~~^~~.~~---_
116TY FROM TO 1! READING; NATURE OF BUSINESS YJM 0 4"$tO5
PO)NT S-1 AR FINISH PER WLE
ot
MCC-
CC
NA
kf-
r en
AUTO LICENSE NO, TOTAIS
+ SPEEDOMETER READING columns are mbo used only when distance between points cannot u"determined b,fixed mileage^,Official highway M^p,
Pursuant m the provisions and penalties*/oh"n-1ss.Acts mss'/hereby"°,titY that,nom,°nOimn*,comot is|u*and correct,that the amount claimed/x legally due,after^u"°u«all/",/credit-
end / /the same has been paid.
o°,°---/l -_----- ------------
J�~��7
� - | --�� [�` ^�»� �~
� '
� i./
/ c/ P . F~ �~~
VAESCRI810 BY STATE SOAKD OF ACCOUNTS GFKFEAL FOMW up IN V9SQ
MILEAGE CLAIM
To__...._.._.. — s--CA!F�—
------ cg�
(WVEANWFK7AL-UNI-0................. ON ACCOUNT OF APPROPRIATION NO. --.- FOR
AUTO
DATE FROM TO I READING 4- 1 NATURE OF BUSINESS MILES
POINT POINT S',ART FINISH 7RAVELEn PM MILE
yy%7r: -------
C
n I - C
M *V AI
• 1
-Kc
1-ove iC :1 19
ry
31
L L
ev-
----------
ON rw
AUTO LICENSE TOTALS
+ SPEEDOMETER READING columns are to be used Only when distance between points cannot be determined by fixed mileage or official highway map. -_9
Pursuant to the provisions and penalties Of Chapter 155,Acts 1953,1 hereby certify that the 10TPgoing account is just and--orrect,that the amount claimed is legal",due, cued".
end th n t of the 0 has been paid.
Date
q3q
S
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.
360144 Canada, Cyndi Terms
11508 Lucky Dan Dr
Noblesville, IN 46060
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO # Amount
7/16/13 Reimb Mileage 4/29 - 6/6/13 $ 106.22
7/16/13 Reimb Mileage 6/6 - 6/26/13 $ 50.73
Total $ 156.95
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.
360144 Canada, Cyndi Allowed 20
11508 Lucky Dan Dr
Noblesville, IN 46060
In Sum of$
$ 156.95
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-5 Reimb 4343000 $ 106.22 1 hereby certify that the attached invoice(s), or
1082-12 Reimb 4343000 $ 50.73 bill(s) is (are)true and correct and that the
materials or services iternized thereon for
which charge is made were ordered and
received except
25-Jul 2013
Signature
$ 156.95 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund