222848 08/13/2013 CITY OF CARMEL, INDIANA VENDOR: 366471 Page 1 of 1
0 ONE CIVIC SQUARE SHANDI BRAY CHECK AMOUNT: $289.28
CARMEL, INDIANA 46032 C/O PARKS
CHECK NUMBER: 222848
CHECK DATE: 8/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 289 . 28 TRAVEL FEES & EXPENSE
I
JUL 3 0 2013
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FOAM 110.101(INS)
MILEAGE CLAIM
TO_
(GOVERNMENTAL W41T) ON ACCOUNT OF APPROPRIATION NO, FOR
(OFFICE,BOARD,DEPARTMENT OR INSTITUTION)
DATE FROM To SREADING PEEDOMET+ER AUTO MILEAGE
NATURE OF BUSINESS MILES a
POINT
POINT START FINISH TRAVELED
PER MILE
k r% 7z6i
..........
2 C L
KA __S-
CAAJ C-1
LC-
14 C-VJ 6 NA C.C. fe
2-L
7— 1
k
cWtc, fjLc(-
paq-Mcrt�-
'45
FT
-----------
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.
Inv
Pursuant to the provisions and penalties of Chapter 155,Acts 1953,1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due,after aliowing all just credits
and that no part of the same has been paid.
Date /7
JUL 3 0 2013
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO.10,(INS)
MILEAGE CLAIM
.....
Ca, Ua I L Paj*,o, (2� TO 61AArNDI
Q(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OP110E,BOARD,DEPARTMENT OR INSTITUTION)
DATE FROM TO SPEEDOMETER
READING + AUTO M G
-13L I NATURE OF BUSINESS MILES @
POINT START FINISH TRAVELED
L
c--v-J -h 1-- .1 -
MCC
ra�MWG in I M"
11 C'W ts
CL
C-L
C&4 I�A
V4
WX
C114-4
C,V11
-45 CM AA0C
C V4 Al f.
C-W + M �-c
tA
............ 91 1
14
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. 32-
Pursuant to the provisions and penalties of Chapter 155,Acts 1953,1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due,after alioviing all justI13,
and that no part of the same has been paid.
Date
0'�
- _-_-
_
— UL o 8 2013
/
"��BED Or STATE BOARD OF°=OUNTS "=~ ==m10*661
MILEAGE CLAIM
--- -----
—'- --- ow ACCOUNT oF APPROPRIATION NO. __ - rpx __- --
SPEEDOMETER
W)m To AUTO WLEAJME
DATL HEADING + NATURE OF BUSINESS MILES ra,
PER MILE
'
—__ 1AC L �
1A n W4
AUTO LICENSE NO. TOTALS
~ opxnoOwszsaosao/wo columns are mu"used only when distance between points cannot be u°w,mi""x by/m"a mu""v°or official highway map.
Pursuant m the provisions and penalties a Chapter as.Acts 1eo.1 hereby certify that the foregoing account/"just"ziu correct.that the amount claimed u Legally due,after^o"°mn all`""k credits
.
°"a that no part of the same has been n"/a
Date __—__-- ---
�W
AUG - 5 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.
366471 Bray, Shandi Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
7/30/13 Reimb Mileage 2/4 - 5/15/13 5 235.04
7/30/13 Reimb Mileage 5/16 - 5/30/13 5 54.24
I
Total $ 289.28
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.
366471 Bray, Shandi Allowed 20
In Sum of$
$ 289.28
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITL AMOUNT Board Members
Dept#
1081-3 Reimb 4343000 $ 235.04 1 hereby certify that the attached invoice(s), or
1081-3 Reimb 4343000 $ 54.24 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
8-Aug 2013
P&I12onoyl
Signature
$ 289.28 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund