HomeMy WebLinkAbout182428 02/17/2010 CITY OF CARMEL, INDIANA VENDOR: 360464 Page 1 of 1
fi ONE CIVIC SQUARE LINDSAY LABAS CHECK AMOUNT: $470.53
CARMEL, INDIANA 46032 111 W MAIN ST APT 2C
CARMEL IN 46032 CHECK NUMBER: 182428
CHECK DATE: 2/1712010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4343000 MILEAGE 174.57 MILEAGE REIMB
1125 4343000 MILEAGE 295.96 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM I A r
TO
(GOVERNMENTAL LJNIT)
ON ACCOUNT OF APPRpPRIATION NO. FOR
1K 4 (OF, E, BOARD, DEPARTMENT OR INSTITUTION) V
SPEEDOMETER
DATE FROM TO i READING AUTO MILEAGE
G
0 T G NATURE OF BUSINESS MILES q E
POINT POINT START FINISH TRAVELED PER MILE
ba H4
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.
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 due, after aliowing all just credits
and that no part of the same has been paid. L7�
Date
000
Z.
Carmel 0 Clay
Parks &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Bud et Description Amount Purpose of Expense
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11 IQ t 5 3 V LunM
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All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. I TOTAL:
Employeen Name (print) D n s Gem. Lc ubo s
Check
Address i h N 14WY1 S'
t,
payable to: City, St, Zip C�we I N U 3 2-
Signature: Z Approved by:
Date: Z� (�j Date: 7Zl
Revised 3 -2 -07 by Business Services;
Shared /Forms and Templates /Business Service Forms /Employee Exp Reimb Request 2007 -3
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Jilt
7'il U V 1N C 1.0 I3 I1011 {1
Lindsay Labas
Room No.
319
Arrival
01 -19 -10
Departure 01 -22 -10
Page No. 1 of 1
Folio No. 134022
Conf. No. 514209
INVOICE
Group Code 1001INDIAN Thank You For Staying With Us! 01 -22 -10
Date Code Description Charqes Credits
01 -19 -10 1000 Room 119.00
01 -19 -10 1500 Indiana Sales Tax 7% 8.33
01 -19 -10 1600 County Innkeepers Tax 5% 5.95
01 -20 -10 1000 Room 59.50
01 -20 -10 1500 Indiana Sales Tax 7% 4.17
01 -20 -10 1600 County Innkeepers Tax 5% 2.98
01 -21 -10 1000 Room 59.50
01 -21 -10 1500 Indiana Sales Tax 7% 4.17
01 -21 -10 1600 County Innkeepers Tax 5% 2.98
01 -22 -10 9005
XX /XX
Total 266.58 266.58
Balance 0.00
Signature:
I agree that my liability for this bill is not waived and agree to be held personally
liable in the event that the indicated person, company, or third party fail
to pay for anypart or all of these charges.
101 N Grant Street West Lafayette, IN 47906 -3574 phone: 765- 494 -8971 fax: 765- 494 -8966 www.hotel.purdue.edu
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.
360464 Labas, Lindsay Terms
111 West Main Street, 2C Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1/28/10 Reimb Mildage 12/2/09 1/22/10 174.57
1/25/10 Reimb 2010 IPRA Conference expenses 295.96
Total 470.53
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.
360464 Labas, Lindsay Allowed 20
111 West Main Street, 2C
Carmel, IN 46032
In Sum of
I
470.53
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 Reimb 4343000 174.57 1 hereby certify that the attached invoice(s), or
1125 Reimb 4343000 295.96 bill(s) is (are) true and correct and that the
/j materials or services itemized thereon for
which charge is made were ordered and
received except
f 11 -Feb 2010
Signature
470.53 Accounts Payable Coordinator
d I st distribution ledger classification if Title
claim paid motor vehicle highway fund