HomeMy WebLinkAbout230358 03/2604 .A ur..C4NM
> CITY OF CARMEL, INDIANA VENDOR: 358408
ONE CIVIC SQUARE TIFFANY BUCKINGHAM CHECK AMOUNT: $*******332.78*
a' CARMEL, INDIANA 46032 5057 E 71 ST STREET CHECK NUMBER: 230358
INDIANAPOLIS IN 46205 CHECK DATE: 03(26/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 332.78 TRAVEL FEES & EXPENSE
Carmel * Clay N4tIONRL APfER-
Parks&Recreation 5C OL ASSOGAl-IC11
Employee Expense Reimbursement Request CLWrE9ENCO
Date of Fund Account Account
Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense
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All receipts should be attached in the same order as listed above. I ,
No sales tax will be reimbursed. TOTAL: $�* I 'j•��
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Address
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payable to: City, St, Zip l t 1�S 1\j qZZ•U
Signature: h � Approved by:
Date: (� Date:
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Revised 3-2-07 by Business Services;
Shared/Forms and Templates/Business Service Forms/Employee Exp Reimb Request 2007-3
Carmel Clay
Parks&Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense
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All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: $ I . O5
Employeen Name(print)
Address
Check
payable to: City, St, Zip I LL(AVIA nL,ks IA� b1b ZZ(�
Signature:' 'VA }'� rJ (�ll�VI � Approved by:
Date: I Date: \L r l
Revised 3-2-07 by Business Services;
Shared/Forms and Templates/Business Service Forms/Employee Exp Reimb Request 2007-3
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO.101(1906)
MILEAGE CLAIM 1
-
(GOVERNMENTAL UNIT) !
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD.DEPARTMENT OR 1NSTITUNOX)
DAT FROM TO I SPEEDOMETER AUTO E
Zb t READING + NATURE OF BUSINESS MILES a c
.J—� POINT POINT START FINISH TRAVELED PER MILE
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AUTO LICENSE NO. TOTALS T7 11 IS)] 'Z..
t 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,I hereby certify that the foregoing account is just and correct, that the amount claimed is legally ue,after aliowing all just credits
and that no part of the same has been paid.
Date
0
s
MARY 3 2014
IF
j
} �y
1 ff not ir
J'
Buckingham
Carmel Clay Parks ft
i Recreation
Carmel, IN
N A? 1 O N A L
A SSOCIOtI
r �
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.
358408 Buckingham, Tiffany Terms
5057 E 71 st St
Indianapolis, IN 46205
Invoice Invoice. Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
3/4/14 Reimb. Mileage 1/16 - 3/4/14 $ 151.20
3/6/14 Reimb. Travel expenses for NAA Conference $ 181.58
Total $ 332.78
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
a.
Voucher No. Warrant No.
358408 Buckingham, Tiffany Allowed 20
5057 E 71st St
Indianapolis, IN 46205
In Sum of$
$ 332.78
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or Board Members
Dept#
INVOICE NO. CCT#/TITL AMOUNT
1081-2 Reimb. 4343000 $ 151.20 1 hereby certify that the attached invoice(s), or
1081-99 Reimb. 4343000 $ 181.58 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
20-Mar 2014
Signature
$ 332.78 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund