253066 01/11/16 J`�.4�gs� CITY OF CARMEL, INDIANA VENDOR: 366663
ONE CIVIC SQUARE AMANDA GILLIM CHECK AMOUNT: $*******162.76*
,;, ;?�; CARMEL, INDIANA 46032 C/O PARKS CHECK NUMBER: 253066
arroN-�o CHECK DATE: 01/11/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 162.76 TRAVEL FEES & EXPENSE
GENERAL FORM NO.101(1086)
PRESCRIBED BY STATE BOARD OF ACCOUNTS
MILEAGE CLAIM 0 J, .
TO
(GOVERNMENTAL UN1?t - : . ON ACCOUNT OF APPROPRIATION NO. FOR
COM,CE,BOARD,DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO EAGE
DATE READING-, + NATURE OF BUSINESS MILES @ n `Q
JJJy---.•L LL POINT FOINT START FINISH TRAVELED P
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AUTO LICENSE NO. ✓ �' ✓ TOTALS2�
+ 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 1953,1 hereby certify that the foregoing account is just and correct,that the amo ai�is leg y due,af�era�la I Bits
and that no p rt Of thP same has been paid.
i
Date '
.qty 31 1VED
0 D E'1." 2 9 2 015
r , J
Carmel o Clay ��e
Parks&Recreation Circ
Coon F -
Employee Expense Reimbursement Request Con F--f—::7
Date of Fund Account Account
Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense
f1iSoY1
12 r �,��1e�gn-WI�ha;,,l �a-w �I -q 4�0 0 00 �h o(i �rx e -"- I r Gc) p �.�.� c c
I 'Zl 1 &)bvvO' 42168 -O A I �9 b" AY vw1 ?P I WV kcz c c
4�MW �Ywfl tm W, V4
19L2- b"UAWJW �&="' 44� 0 -�Y 3,9 65 c, -f6M/d felfave-4
VVLkA
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: -d
Employee Name(print) Amand 'a k 114
Address .
Check
payable to: City, St, Zip 1111%A,(;L e}',a
nat e: Approved by:
Date: ` Date:
Business Services Division,Revised 7-7-08 c7F
FILE: Shared\AdministrativelForms\Staff Forms\Employee Exp Reimb Request
I
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
Aninvoice ofbill tobeproperly itemized must show; kind ofservice,where performed, dates service rendered, by
whom, rates per day, numberofhours, rate per hour, numberof units, priceitetc,
Payee
Purchase Order No.
366663 Gi!|irD' ADlaiDda Terms
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)= PO# Amount
12/18/15 Reimb Mileage 8/17- 12/17/15 $ 116.21
12/18/15 Reimb Travel Expenses for"Because Kids Count' conf. $ 46.55
Total $ 162.76
1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
with|C5-11-1n4.0
� 20___
'
Clerk-Treasurer
_ _
Voucher No. Warrant No.
3566
'3 GiUinn,&manda \ Allowed 20____
In
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[NNACCOUNT OF APPROPRIATION FOR )
10@-ESE `
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PO#or INVOICE NO. ACCT AITITLE AMOUNT
Board Members
Dept1081-5 Reimb 4343000 $ 116.21� /
(
' \ hereby certify that the attached invo\ue(s). ur
' biU(s)|a(anm)boeand conemtand that the
� matoho|sorservices itemized thereon for
| which charge inmade were ordered and
received except
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/
! Decan)bar2A 2015
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Signature
1 $ 162.76 Accounts Payable Coordinator
Cost distribution ledger classification if Title
|
claim paid motor vehicle highway fund
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