223416 08/27/2013 CITY OF CARMEL, INDIANA VENDOR: 360144 Page 1 of 1
ONE CIVIC SQUARE CYNTHIA CANADA CHECK AMOUNT: $124.46
CARMEL, INDIANA 46032 11508 LUCKY DAN DRIVE
NOBLESVILLE IN 46060 CHECK NUMBER: 223416
CHECK DATE: 8/27/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 53 . 33 TRAVEL FEES & EXPENSE
1082 4343000 REIMB 71 . 13 TRAVEL FEES & EXPENSE
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AUG 20 2013
PRESCRIBED BY STATE BOARD OF ACCOUNTS '
FORK NO.ICI(L9R6)
MILEAGE CLAIM
TO—__
(GOVERMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(O .BOARD.DEPARTMENT OR INSTITUTION)
DATE FROM •O SPFZDOMETER AUTO AGE
V .
READING +
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MILE
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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. $ ,a�Cre Pursu ant to the provisions and penalties of Chapter 15S,Acts 1953,I hereby certify that the foregoing account is just and correct,that the amount claimed is legally due,after allowing all jts:
and that no p1art of, same has been paid.
Date� Y-)I I -
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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
8/19/13 Reimb Mileage 7/29 - 8/19/13 $ 53.33
8/19/13 Reimb Mileage 7/2 - 7/26/13 $ 71.13
Total $ 124.46
I 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$
$ 124.46
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-5 Reimb 4343000 $ 53.33 1 hereby certify that the attached invoice(s), or
1082--13 Reimb 4343000 $ 71.13 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
22-Aug 2013
Signature
$ 124.46 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund