231377 04/08/14 `'�_��qM` CITY OF CARMEL, INDIANA VENDOR: 368106
s ® it ONE CIVIC SQUARE JACKIE REDMOND CHECK AMOUNT: S"''"""'34.60*
r• ;? CARMEL, INDIANA 46032 CHECK NUMBER: 231377
'y,Toa�° CHECK DATE: 04/08114
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 34.60 TRAVEL FEES & EXPENSE
Carmel o Clay
Parks&Recreate®n
Employee Expense Reimbursement Request
Date of Fund Account Account
R ceipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense
514-) '.,0 VJ,,, log1-q q3q 3vov •r 4U� r KP G °G �Q,�oh. r x e
All receipts should be attached in the same order as listed above. _
No sales tax will be reimbursed. TOTAL: t ,
Employee Name(print) �{ � PjQ�A0�JD
Address
Check
payable to: City, St, Zip
Signature: Approved by:
Date: _5 J �7`" Date:
Business Services Division,Revised 7-7-08
C�IVED
FILE: Shared\Forms\Business Services\Employee Exp Reimb Request � Z 2014BY:
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PRI-SCRIBED BY STATE BOARD Or ACCOUNTS
GENERAL FORM 110.10)(1986)
MILEAGE CL IM
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(GOVERNMENTAL UNIT) ACCOU 4T F APPROPRIATION NO. FOR
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(Or:1CH,HOARD,DEPAATI[!;l('T OA INSTiTUrIOH)
SPEEDO ETER
DA/TgJ/ FROM TO READ, + AUTO }AILEAGE
NATURE OF BUSINESS
POINT POINT STAR? FINISH j ES s� T
1'AAV£LEO PER MILE/
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AUTO LICENSE NO. 1 TOTALS
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+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determint d by Six d i ileage or otlicial highwaymap.
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Pursuant to the provisions and penalties of Chapter 255,Acts 1853,1 hereby certify that the foregoing account is ju a d correct,that the amount claimed is legally due,after a Ing all just credits
end that no part of the same has been paid.
Date
/ 1
EIVED
MAR 2 4 2014
BYf
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.
Redmond, Jackie Terms
209 Surrey Hill Ct
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
3/4/14 Reimb Pacer game parking Field trip $ 15.00
3/4/14 Reimb Mileage 3/4/14 $ 19.60
Total $ 34.60
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.
Redmond, Jackie Allowed 20
209 Surrey Hill Ct
Carmel, IN 46032
In Sum of$
$ 34.60
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-4 Reimb 4343000 $ 15.00 1 hereby certify that the attached invoice(s), or
1081-4 Reimb 4343000 $ 19.60 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
3-Apr 2014
Signature
$ 34.60 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund