226079 11/18/2013 CITY OF CARMEL, INDIANA VENDOR: 367093 Page 1 of 1
ONE CIVIC SQUARE ALYSSA CLARK
CARMEL, INDIANA 46032 CIO PARKS CHECK AMOUNT: $42.94
CHECK NUMBER: 226079
CHECK DATE: 11118/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 42 . 94 TRAVEL FEES & EXPENSE
NOV - 5 2013
i
BY: -1
PRfSCR18 L0 BY STATE BOARD OF ACCOUNTS
GENERAL FORD HC.101(1906}
S MILEAGE CL IM 1 SSa MA-
(SSE _ 4STARTF IGOVERN14ENTAL UHM F APPROPRIATION NO. FOR tOF710E,HOARb,bETARTIQNT OR INSTITUTION)
DATE FROM TO MILEOS (q Q_T PORJT POINT NATURE OF BUSINESS TRAVELED PER MILE
130 F p CG
I 0 Z �D� i )
10 MCC. w _-
1 7 DE
1Q_ C — —
4 G
1 v fAm i
10 1 LO
I C 10 MCC
CC cC 5 --- cc --
;«
AUTO LICENSE NO. TOTALS
I
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be deLermint d by fix d i ideage or official highway.map.
Pursuant to the provisions and penalties of Chapter 155,Acts 1953,I hereby certify that the foregoing account is ju a d correct, that the amount claimed is legally due,after allowing all just credits.
and that no part of the same has been paid.
- i
Date
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.
367093 Clark, Alyssa Terms
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
1115/13 Reimb Mileage 9/25 - 11/5/13 $ 42.94
Total $ 42.94
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.
367093 Clark, Alyssa Allowed 20
In Sum of$
$ 42.94
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-4 Reimb 4343000 $ 42.94 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
14-Nov 2013
11
Signature
$ 42.94 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund